%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65028 %T Forecasting Subjective Cognitive Decline: AI Approach Using Dynamic Bayesian Networks %A Etholén,Antti %A Roos,Teemu %A Hänninen,Mirja %A Bouri,Ioanna %A Kulmala,Jenni %A Rahkonen,Ossi %A Kouvonen,Anne %A Lallukka,Tea %+ Department of Public Health, University of Helsinki, PO Box 20, Tukholmankatu 8 B, Helsinki, 00014, Finland, 358 445105010, antti.etholen@helsinki.fi %K artificial intelligence %K AI %K dementia %K aging %K smoking %K alcohol consumption %K leisure time physical activity %K consumption of fruit and vegetables %K body mass index %K BMI %K insomnia symptoms %D 2025 %7 6.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. Objective: We examined multifactorial trajectories of risk factors and their associations with SCD using an artificial intelligence (AI) approach to build a score calculator that forecasts later SCD. In addition, we aimed to develop a new risk score tool to facilitate personalized risk assessment and intervention planning and to validate SCD against register-based dementia diagnoses and dementia-related medications. Methods: Five repeated surveys (2000-2022) of the Helsinki Health Study (N=8960; n=7168, 80% women, aged 40-60 years in phase 1) were used to build dynamic Bayesian networks for estimating the odds of SCD. The model structure was developed using expert knowledge and automated techniques, implementing a score-based approach for training dynamic Bayesian networks with the quotient normalized maximum likelihood criterion. The developed model was used to predict SCD (memory, learning, and concentration) based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure time physical activity, BMI, and insomnia symptoms, adjusting for sociodemographic covariates. Model performance was assessed using 5-fold cross-validation to calculate the area under the receiver operating characteristic curve. Bayesian credible intervals were used to quantify uncertainty in model estimates. Results: Of the participants, 1842 of 5865 (31%) reported a decline in memory, 2818 of 5879 (47.4%) in learning abilities, and 1828 of 5888 (30.7%) in concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Moreover, our validation confirmed that SCD has prognostic value for diagnosed dementia, with individuals reporting memory decline being over 3 times more likely to have dementia in 2017 (age 57-77 years), and this risk increased to more than 5 times by 2022 (age 62-82 years). The receiver operating characteristic curve analysis further supported the predictive validity of our outcome, with an area under the curve of 0.78 in 2017 and 0.75 in 2022. Conclusions: A new risk score tool was developed that enables individuals to inspect their risk profiles and explore potential targets for interventions and their estimated contributions to later SCD. Using AI-driven predictive modeling, the tool can aid health care professionals in providing personalized prevention strategies. A dynamic decision heatmap was presented as a communication tool to be used at health care consultations. Our findings suggest that early identification of individuals with SCD could improve targeted intervention strategies for reducing dementia risk. Future research should explore the integration of AI-based risk prediction models into clinical workflows and assess their effectiveness in guiding lifestyle interventions to mitigate SCD and dementia. %M 40327854 %R 10.2196/65028 %U https://www.jmir.org/2025/1/e65028 %U https://doi.org/10.2196/65028 %U http://www.ncbi.nlm.nih.gov/pubmed/40327854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65879 %T Characterizing Patient-Reported Fatigue Using Electronic Diaries in Neurodegenerative and Immune-Mediated Inflammatory Diseases: Observational Study %A Bennetot,Adrien %A Zia Ur Rehman,Rana %A Romijnders,Robbin %A Li,Zhi %A Macrae,Victoria %A Davies,Kristen %A Ng,Wan-Fai %A Maetzler,Walter %A Kudelka,Jennifer %A Hildesheim,Hanna %A Emmert,Kirsten %A Paulides,Emma %A van der Woude,C Janneke %A Reilmann,Ralf %A Aufenberg,Svenja %A Chatterjee,Meenakshi %A Manyakov,Nikolay V %A Pinaud,Clémence %A Avey,Stefan %K chronic disease %K fatigue %K neurodegenerative diseases %K immune-mediated inflammatory diseases %K diary, patient-reported outcomes %K electronic diaries %K digital technologies %K digital health %K eHealth %K mobile phone %D 2025 %7 5.5.2025 %9 %J JMIR Form Res %G English %X Background: Fatigue is a prevalent and debilitating symptom in many chronic conditions, including immune-mediated inflammatory diseases (IMIDs) and neurodegenerative diseases (NDDs). Fatigue often fluctuates significantly within and between days, yet traditional patient-reported outcomes (PROs) typically rely on recall periods of a week or more, potentially missing these short-term variations. The development of digital tools, such as electronic diaries (eDiaries), offers a unique opportunity to collect granular, real-time data. However, the feasibility, adherence, and comparability of eDiary-based assessments to established PROs require further investigation. Objective: This study aimed to evaluate the feasibility and acceptability of using a high-frequency eDiary to capture intraday variability in fatigue and to compare eDiary data with scores obtained from the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), a validated weekly recall PRO. Methods: Data were collected from 159 participants enrolled in the IDEA-FAST (Identifying Digital Endpoints to Assess Fatigue, Sleep and Activities in Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases) feasibility study; a 4-week prospective observational study conducted at 4 European centers. Participants included individuals with NDDs (n=39), IMIDs (n=78), and healthy volunteers (n=42). Participants used an eDiary to report their physical and mental fatigue levels up to 4 times daily on a 7-point Likert scale (0=low and 6=high). Adherence was calculated as the proportion of completed eDiary entries relative to the total expected entries. Correlations between averaged eDiary scores and weekly FACIT-F scores were analyzed. Results: Adherence to the eDiary protocol was 5505/8880 (61.99%) overall, varying by cohort, with the highest adherence (1117/1200, 93.07%) observed in the primary Sjögren syndrome cohort and the lowest adherence in the Parkinson disease (410/960, 42.7%) and Huntington disease (320/720, 44.4%) cohorts. The average adherence was 430/1680 (43.45%) in the NDD cohorts and 3367/4560 (73.84%) in the IMID cohorts. Fatigue levels showed clear diurnal variation, with significantly higher fatigue reported in the evening compared to the morning (P<.001). A moderate correlation (Spearman=0.46, P<.001) was observed between eDiary fatigue scores and FACIT-F scores, with stronger cohort-specific associations for certain FACIT-F items. These results indicate that eDiaries provide complementary insights to weekly PROs by capturing intraday fluctuations in fatigue. Conclusions: This study demonstrates the feasibility, acceptability, and validity of using high-frequency eDiaries to assess fatigue in chronic conditions. By effectively detecting intra- and interday fatigue variations, eDiaries complement traditional PROs such as FACIT-F, offering a more nuanced understanding of fatigue patterns. Future research should explore optimized eDiary protocols to balance participant burden with data granularity. %R 10.2196/65879 %U https://formative.jmir.org/2025/1/e65879 %U https://doi.org/10.2196/65879 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e68890 %T Online Communities as a Support System for Alzheimer Disease and Dementia Care: Large-Scale Exploratory Study %A Kaliappan,Sidharth %A Liu,Chunyu %A Jain,Yoshee %A Karkar,Ravi %A Saha,Koustuv %+ Siebel School of Computing and Data Science, The Grainger College of Engineering, University of Illinois Urbana-Champaign, 201 N. Goodwin Ave, Siebel Center for Computer Science, 4212, Urbana, IL, 61801, United States, 1 2172443824, ksaha2@illinois.edu %K social media %K natural language %K Alzheimer disease %K social support %K online communities %K machine learning %D 2025 %7 5.5.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease (AD) is the leading type of dementia, demanding comprehensive understanding and intervention strategies. In the United States, where over 6 million people are impacted, the prevalence of AD and related dementias (AD/ADRD) presents a growing public health challenge. However, individuals living with AD/ADRD and their caregivers frequently express feelings of marginalization, describing interactions characterized by perceptions of patient infantilization and a lack of respect. Objective: This study aimed to address 2 key research questions (RQs). For RQ1, we investigated the needs and concerns expressed by participants in online social communities focused on AD/ADRD, specifically on 2 platforms–Reddit’s r/Alzheimers and ALZConnected. For RQ2, we examined the prevalence and distribution of social support corresponding to these needs and concerns, and the association between these needs and received support. Methods: We collected 13,429 posts and comments from the r/Alzheimers subreddit spanning July 2014 to November 2023, and 90,113 posts and comments from ALZConnected between December 2020 (the community’s earliest post) and November 2023. We conducted topic modeling using latent Dirichlet allocation (LDA), followed by labeling to identify the major topical themes of discussions. We used transfer learning classifiers to identify the occurrences of emotional support (ES) and informational support (IS) in the comments (or responses) in the discussions. We built regression models to examine how various topical themes are associated with the kinds of support received. Results: Our analysis revealed a diverse range of topics reflecting community members’ varying needs and concerns of individuals affected by AD/ADRD. These themes encapsulate the primary discussions within the online communities: memory care, nursing and caregiving, gratitude and acknowledgment, and legal and financial considerations. Our findings indicated a higher prevalence of IS compared to ES. Regression models revealed that ES primarily occurs in posts relating to nursing and caring, and IS primarily occurs in posts concerning medical conditions and diagnosis, legal and financial, and caregiving at home. Conclusions: This study reveals that online communities dedicated to AD/ADRD support engage in discussions on a wide range of topics, such as memory care, nursing, caregiving, and legal and financial challenges. The findings shed light on the key pain points and concerns faced by individuals managing AD/ADRD in their households, revealing how they leverage online platforms for guidance and support. These insights underscore the need for targeted institutional and social interventions to address the specific needs of AD/ADRD patients, caregivers, and other family members. %M 40324770 %R 10.2196/68890 %U https://aging.jmir.org/2025/1/e68890 %U https://doi.org/10.2196/68890 %U http://www.ncbi.nlm.nih.gov/pubmed/40324770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65667 %T Implementation of Telemedicine for Patients With Dementia and Their Caregivers: Scoping Review %A Ye,Mengfei %A Liu,Zheng %A Xie,Weigen %A Shou,Mengna %A Wang,Shengpang %A Lin,Xuebing %A Xu,Yan %A Yao,Miner %A Chen,Jialu %A Shou,Yunli %A Wu,Jingzhu %A Guan,Lili %+ Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shengli West Road, Yuecheng District, Shaoxing, 312000, China, 86 13957501678, lilyg1678@qq.com %K telemedicine %K dementia %K mobile phone %K implementation %K telehealth %K scoping review %K family caregiver %K systematic search %K mental health %K mental illness %K mental disorder %D 2025 %7 5.5.2025 %9 Review %J J Med Internet Res %G English %X Background: As dementia advances, symptoms and associated concerns lead to significant distress for both the patients and their caregivers. Telemedicine has the capacity to alleviate care-related issues for patients with dementia and their family caregivers. Objective: This study aims to synthesize the implementation strategies for providing telemedicine to assist patients with dementia and their caregivers in home and community settings and to examine its effectiveness and implementation barriers. Methods: In accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a systematic search was conducted across 6 databases, including MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and ProQuest. The eligibility criteria for peer-reviewed English publications from January 2000 up to January 2025 encompassed research studies related to telemedicine services for individuals diagnosed with dementia and caregivers. Results: This study included 54 articles, comprising 14,446 participants from 10 countries. In total, 4 major themes emerged from the articles: the design of telemedicine services, effectiveness of telemedicine, external environmental factors, and barriers in telemedicine implementation. Cognitive training was addressed in 28 studies. Within the domain of work and leisure, 24 solutions were identified. Most reviewed studies indicated favorable experiences with telemedicine services and highlighted perceived personal and social benefits among patients with dementia, as well as identified barriers to accessing and using such services. Conclusions: Future studies should encompass the enhancement of digital accessibility for individuals with restricted resources and limited technological proficiency, the use of randomized controlled trial methodologies to ascertain the comparative efficacy of various service delivery modes, and the augmentation of sample diversity. %M 40324768 %R 10.2196/65667 %U https://www.jmir.org/2025/1/e65667 %U https://doi.org/10.2196/65667 %U http://www.ncbi.nlm.nih.gov/pubmed/40324768 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65551 %T Current Technological Advances in Dysphagia Screening: Systematic Scoping Review %A Wong,Duo Wai-Chi %A Wang,Jiao %A Cheung,Sophia Ming-Yan %A Lai,Derek Ka-Hei %A Chiu,Armstrong Tat-San %A Pu,Dai %A Cheung,James Chung-Wai %A Kwok,Timothy Chi-Yui %+ Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, GH137, GH Wing, 1/F, Department of Biomedical Engineering,, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, 999077, China (Hong Kong), 852 27667673, james.chungwai.cheung@polyu.edu.hk %K digital health %K computer-aided diagnosis %K computational deglutition %K machine learning %K deep learning %K artificial intelligence %K AI %K swallowing disorder %K aspiration %D 2025 %7 5.5.2025 %9 Review %J J Med Internet Res %G English %X Background: Dysphagia affects more than half of older adults with dementia and is associated with a 10-fold increase in mortality. The development of accessible, objective, and reliable screening tools is crucial for early detection and management. Objective: This systematic scoping review aimed to (1) examine the current state of the art in artificial intelligence (AI) and sensor-based technologies for dysphagia screening, (2) evaluate the performance of these AI-based screening tools, and (3) assess the methodological quality and rigor of studies on AI-based dysphagia screening tools. Methods: We conducted a systematic literature search across CINAHL, Embase, PubMed, and Web of Science from inception to July 4, 2024, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. In total, 2 independent researchers conducted the search, screening, and data extraction. Eligibility criteria included original studies using sensor-based instruments with AI to identify individuals with dysphagia or unsafe swallow events. We excluded studies on pediatric, infant, or postextubation dysphagia, as well as those using non–sensor-based assessments or diagnostic tools. We used a modified Quality Assessment of Diagnostic Accuracy Studies–2 tool to assess methodological quality, adding a “model” domain for AI-specific evaluation. Data were synthesized narratively. Results: This review included 24 studies involving 2979 participants (1717 with dysphagia and 1262 controls). In total, 75% (18/24) of the studies focused solely on per-individual classification rather than per–swallow event classification. Acoustic (13/24, 54%) and vibratory (9/24, 38%) signals were the primary modality sources. In total, 25% (6/24) of the studies used multimodal approaches, whereas 75% (18/24) used a single modality. Support vector machine was the most common AI model (15/24, 62%), with deep learning approaches emerging in recent years (3/24, 12%). Performance varied widely—accuracy ranged from 71.2% to 99%, area under the receiver operating characteristic curve ranged from 0.77 to 0.977, and sensitivity ranged from 63.6% to 100%. Multimodal systems generally outperformed unimodal systems. The methodological quality assessment revealed a risk of bias, particularly in patient selection (unclear in 18/24, 75% of the studies), index test (unclear in 23/24, 96% of the studies), and modeling (high risk in 13/24, 54% of the studies). Notably, no studies conducted external validation or domain adaptation testing, raising concerns about real-world applicability. Conclusions: This review provides a comprehensive overview of technological advancements in AI and sensor-based dysphagia screening. While these developments show promise for continuous long-term tele-swallowing assessments, significant methodological limitations were identified. Future studies can explore how each modality can target specific anatomical regions and manifestations of dysphagia. This detailed understanding of how different modalities address various aspects of dysphagia can significantly benefit multimodal systems, enabling them to better handle the multifaceted nature of dysphagia conditions. %M 40324167 %R 10.2196/65551 %U https://www.jmir.org/2025/1/e65551 %U https://doi.org/10.2196/65551 %U http://www.ncbi.nlm.nih.gov/pubmed/40324167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63654 %T Systematic Identification of Caregivers of Patients Living With Dementia in the Electronic Health Record: Known Contacts and Natural Language Processing Cohort Study %A Martin,Daniel %A Lyons,Jason %A Powers,J David %A Daddato,Andrea E %A Boxer,Rebecca S %A Bayliss,Elizabeth %A Portz,Jennifer Dickman %+ Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine Anschutz Medical Campus, 1635 Aurora Court, 5th Floor, Aurora, CO, 80045, United States, 1 7208482300, Jennifer.Portz@cuanschutz.edu %K caregivers %K dementia %K electronic health record %K natural language processing %K patient-centered care %K patient portal %D 2025 %7 5.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Systemically identifying caregivers in the electronic health record (EHR) is a critical step for delivering patient-centered care, enhancing care coordination, and advancing research and population health efforts in caregiving. Despite EHRs being effective in identifying patients through standardized data fields like demographics, laboratory results, medications, and diagnoses, identifying caregivers through the EHR is challenging in the absence of specific caregiver fields. Objective: Recognizing the complexity of identifying caregiving networks of people living with dementia, this study aims to systematically capture caregiver information by combining EHR structured fields, unstructured notes, and free text. Methods: Among a cohort of people living with dementia aged 60 years and older from Kaiser Permanente Colorado, caregiver names were identified by combining structured patient contact fields, that is, known contacts, with name-matching and natural language processing techniques of unstructured notes and patient portal messages containing caregiver terms. Results: Among the cohort of 789 people living with dementia, 95% (n=749) had at least 1 caregiver name listed in structured fields (mean 2.1 SD 1.1). Over 95% of the cohort had caregiver terms mentioned near a known contact name in unstructured encounter notes, with 35% having a full name match in unstructured patient portal messages. The natural language processing model identified 7556 “new” names in the unstructured EHR text containing caregiver terms among 99% of the cohort with high accuracy and reliability (F1-score=.85; precision=.89; recall=.82). Overall, 87% of the cohort had a new name identified ≥2 near a caregiver term in their notes and portal messages. Conclusions: Patterns in caregiver-related information were distributed across structured and unstructured EHR fields, emphasizing the importance of integrating both data sources for a comprehensive understanding of caregiving networks. A framework was developed to systematically identify potential caregivers across caregiving networks using structured and unstructured EHR data. This approach has the potential to improve health services for people living with dementia and their caregivers. %M 40324164 %R 10.2196/63654 %U https://www.jmir.org/2025/1/e63654 %U https://doi.org/10.2196/63654 %U http://www.ncbi.nlm.nih.gov/pubmed/40324164 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67437 %T Using Machine Learning to Predict Cognitive Decline in Older Adults From the Chinese Longitudinal Healthy Longevity Survey: Model Development and Validation Study %A Ren,Hao %A Zheng,Yiying %A Li,Changjin %A Jing,Fengshi %A Wang,Qiting %A Luo,Zeyu %A Li,Dongxiao %A Liang,Deyi %A Tang,Weiming %A Liu,Li %A Cheng,Weibin %K older adults %K cognitive decline %K Alzheimer disease %K machine learning %K blood biomarkers %K disease history %K Mini-Mental State Examination %K MMSE %K Chinese Longitudinal Healthy Longevity Survey %K CLHLS %D 2025 %7 30.4.2025 %9 %J JMIR Aging %G English %X Background: Cognitive impairment, indicative of Alzheimer disease and other forms of dementia, significantly deteriorates the quality of life of older adult populations and imposes considerable burdens on families and health care systems worldwide. The early identification of individuals at risk for cognitive impairment through a convenient and rapid method is crucial for the timely implementation of interventions. Objective: The objective of this study was to explore the application of machine learning (ML) to integrate blood biomarkers, life behaviors, and disease history to predict the decline in cognitive function. Methods: This approach uses data from the Chinese Longitudinal Healthy Longevity Survey. A total of 2688 participants aged 65 years or older from the 2008‐2009, 2011‐2012, and 2014 Chinese Longitudinal Healthy Longevity Survey waves were included, with cognitive impairment defined as a Mini-Mental State Examination (MMSE) score below 18. The dataset was divided into a training set (n=1331), an internal test set (n=333), and a prospective validation set (n=1024). Participants with a baseline MMSE score of less than 18 were excluded from the cohort to ensure a more accurate assessment of cognitive function. We developed ML models that integrate demographic information, health behaviors, disease history, and blood biomarkers to predict cognitive function at the 3-year follow-up point, specifically identifying individuals who are at risk of experiencing significant declines in cognitive function by that time. Specifically, the models aimed to identify individuals who would experience a significant decline in their MMSE scores (less than 18) by the end of the follow-up period. The performance of these models was evaluated using metrics including accuracy, sensitivity, and the area under the receiver operating characteristic curve. Results: All ML models outperformed the MMSE alone. The balanced random forest achieved the highest accuracy (88.5% in the internal test set and 88.7% in the prospective validation set), albeit with a lower sensitivity, while logistic regression recorded the highest sensitivity. SHAP (Shapley Additive Explanations) analysis identified instrumental activities of daily living, age, and baseline MMSE scores as the most influential predictors for cognitive impairment. Conclusions: The incorporation of blood biomarkers, along with demographic, life behavior, and disease history into ML models offers a convenient, rapid, and accurate approach for the early identification of older adult individuals at risk of cognitive impairment. This method presents a valuable tool for health care professionals to facilitate timely interventions and underscores the importance of integrating diverse data types in predictive health models. %R 10.2196/67437 %U https://aging.jmir.org/2025/1/e67437 %U https://doi.org/10.2196/67437 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e68147 %T Perceptions of the Use of Mobile Apps to Assess Sleep-Dependent Memory in Older Adults With Subjective and Objective Cognitive Impairment: Focus Group Approach %A Lam,Aaron %A Simonetti,Simone %A D'Rozario,Angela %A Ireland,David %A Bradford,DanaKai %A Fripp,Jurgen %A Naismith,Sharon L %K aging %K mild cognitive impairment %K subjective cognitive impairment %K digital health %K cognition %K neuropsychology %K sleep %D 2025 %7 28.4.2025 %9 %J JMIR Aging %G English %X Background: Sleep-dependent memory (SDM) is the phenomenon where newly obtained memory traces are consolidated from short-term memory stores to long-term memory, underpinning memory for daily life. Administering SDM tasks presents considerable challenges, particularly for older adults with memory concerns, due to the need for sleep laboratories and research staff being present to administer the task. In response, we have developed a prototype mobile app aimed at automating the data collection process. Objective: This study investigates the perspectives of older adults, with subjective or objective cognitive impairment, regarding barriers and facilitators to using a new mobile app for at-home assessment of SDM. Methods: In total, 11 participants aged 50 years and older were recruited from the Healthy Brain Ageing memory clinic, a specialized research memory clinic that focuses on the assessment and early intervention of cognitive decline. Two focus groups were conducted and thematically analyzed using NVivo (version 13; Lumivero). Results: On average, participants were aged 68.5 (SD 5.1) years, and 4/11 were male. Eight participants had subjective cognitive impairment, and 3 participants had mild cognitive (objective) impairment. Two main themes emerged from the focus groups, shedding light on participants’ use of mobile phones and the challenges and facilitators associated with transitioning from traditional laboratory-based assessments to home assessments. These challenges include maintaining accurate data, engaging with humans versus robots, and ensuring accessibility and task compliance. Additionally, potential solutions to these challenges were identified. Conclusions: Our findings underscore the importance of app flexibility in accommodating diverse user needs and preferences as well as in overcoming barriers. While some individuals required high-level assistance, others expressed the ability to navigate the app independently or with minimal support. In conclusion, older adults provided valuable insights into the app modifications, user needs, and accessibility requirements enabling home-based SDM assessment. %R 10.2196/68147 %U https://aging.jmir.org/2025/1/e68147 %U https://doi.org/10.2196/68147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64007 %T Uncovering Social States in Healthy and Clinical Populations Using Digital Phenotyping and Hidden Markov Models: Observational Study %A Leaning,Imogen E %A Costanzo,Andrea %A Jagesar,Raj %A Reus,Lianne M %A Visser,Pieter Jelle %A Kas,Martien J H %A Beckmann,Christian F %A Ruhé,Henricus G %A Marquand,Andre F %+ Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Trigon Building, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands, 31 24 361 42 44, imogen.leaning@donders.ru.nl %K passive monitoring %K mobile health %K mHealth %K smartphone %K mobile phone %K digital phenotyping %K hidden Markov model %K social behavior %K Alzheimer disease %K cognitive impairment %K schizophrenia %D 2025 %7 28.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Brain-related disorders are characterized by observable behavioral symptoms, for example, social withdrawal. Smartphones can passively collect behavioral data reflecting digital activities such as communication app usage and calls. These data are collected objectively in real time, avoiding recall bias, and may, therefore, be a useful tool for measuring behaviors related to social functioning. Despite promising clinical utility, analyzing smartphone data is challenging as datasets often include a range of temporal features prone to missingness. Objective: Hidden Markov models (HMMs) provide interpretable, lower-dimensional temporal representations of data, allowing for missingness. This study aimed to investigate the HMM as a method for modeling smartphone time series data. Methods: We applied an HMM to an aggregate dataset of smartphone measures designed to assess phone-related social functioning in healthy controls (HCs) and participants with schizophrenia, Alzheimer disease (AD), and memory complaints. We trained the HMM on a subset of HCs (91/348, 26.1%) and selected a model with socially active and inactive states. Then, we generated hidden state sequences per participant and calculated their “total dwell time,” that is, the percentage of time spent in the socially active state. Linear regression models were used to compare the total dwell time to social and clinical measures in a subset of participants with available measures, and logistic regression was used to compare total dwell times between diagnostic groups and HCs. We primarily reported results from a 2-state HMM but also verified results in HMMs with more hidden states and trained on the whole participant dataset. Results: We identified lower total dwell times in participants with AD (26/257, 10.1%) versus withheld HCs (156/257, 60.7%; odds ratio 0.95, 95% CI 0.92-0.97; false discovery rate [FDR]–corrected P<.001), as well as in participants with memory complaints (57/257, 22.2%; odds ratio 0.97, 95% CI 0.96-0.99; FDR-corrected P=.004). The result in the AD group was very robust across HMM variations, whereas the result in the memory complaints group was less robust. We also observed an interaction between the AD group and total dwell time when predicting social functioning (FDR-corrected P=.02). No significant relationships regarding total dwell time were identified for participants with schizophrenia (18/257, 7%; P>.99). Conclusions: We found the HMM to be a practical, interpretable method for digital phenotyping analysis, providing an objective phenotype that is a possible indicator of social functioning. %M 40294408 %R 10.2196/64007 %U https://www.jmir.org/2025/1/e64007 %U https://doi.org/10.2196/64007 %U http://www.ncbi.nlm.nih.gov/pubmed/40294408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64713 %T Decision-Making Process of Home and Social Care Professionals Using Telemonitoring of Activities of Daily Living for Risk Assessment: Embedded Mixed Methods Multiple-Case Study %A Filiou,Renée-Pier %A Couture,Mélanie %A Lussier,Maxime %A Aboujaoudé,Aline %A Paré,Guy %A Giroux,Sylvain %A Kenfack Ngankam,Hubert %A Belchior,Patricia %A Bottari,Carolina %A Bouchard,Kevin %A Gaboury,Sébastien %A Gouin-Vallerand,Charles %A Etindele Sosso,Faustin Armel %A Bier,Nathalie %+ Centre de recherche sur le vieillissement (CdRV), Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, QC, J1H4C4, Canada, 1 819 821 8000, renee-pier.filiou@usherbrooke.ca %K activities of daily living %K older adults %K cognitive deficits %K telemonitoring %K clinical decisions %K public health care system %K home care services %K mixed methods %K multiple-case study %D 2025 %7 25.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults with cognitive deficits face difficulties in recalling daily challenges and lack self-awareness, impeding home care clinicians from obtaining reliable information on functional decline and home care needs and possibly resulting in suboptimal service delivery. Activity of daily living (ADL) telemonitoring has emerged as a tool to optimize evaluation of ADL home care needs. Using ambient sensors, ADL telemonitoring gathers information about ADL behaviors such as preparing meals and sleeping. However, there is a significant gap in understanding on how ADL telemonitoring data can be integrated into clinical reasoning to better target home care services. Objective: This paper aims to describe (1) how ADL telemonitoring data are used by clinicians to maintain care recipients with cognitive deficits at home and (2) the impact of ADL telemonitoring on home care service delivery. Methods: We used an embedded mixed methods multiple-case study design to examine 3 health institutions located in the greater Montreal region in Quebec that offer public home care services. An ADL telemonitoring system—Innovative Easy Assistance System–Support for Older Adults’ Autonomy (Soutien à l’autonomie des personnes âgées in French)—was deployed within these 3 health institutions for 4 years. Subcases (care recipient, informal caregiver, and clinicians) were embedded within each case. For this paper, we used the data collected during interviews (45-60 min) with clinicians only. Quantitative metadata were also collected on each service provided to care recipients before and after the implementation of NEARS-SAPA to triangulate the qualitative data. Results: We analyzed 27 subcases comprising 29 clinicians who completed 57 postimplementation interviews concerning 147 telemonitoring reports. Data analysis showed a 4-step decision-making process used by clinicians: (1) extraction of relevant telemonitoring data, (2) comparison of telemonitoring data with other sources of information, (3) risk assessment of the care recipient’s ADL performance and ability to remain at home, and (4) maintenance or modification of the intervention plan. Quantitative data reporting the number of services received allowed the triangulation of qualitative data pertaining to step 4. Overall, the results suggest a stabilization in monthly services after the introduction of the ADL telemonitoring system, particularly in cases where the number of services were increasing before its implementation. This is consistent with qualitative data indicating that, in light of the telemonitoring data, most clinicians decided to maintain the current intervention plan rather than increase or reduce services. Conclusions: Results suggest that ADL telemonitoring contributed to service optimization on a case-by-case basis. ADL telemonitoring may have an important role in reassuring clinicians about their risk management and the appropriateness of service delivery, especially when questions remain regarding the relevance of services. Future studies may further explore the benefits of ADL telemonitoring for public health care systems with larger-scale implementation studies. International Registered Report Identifier (IRRID): RR2-10.2196/52284 %M 40279629 %R 10.2196/64713 %U https://www.jmir.org/2025/1/e64713 %U https://doi.org/10.2196/64713 %U http://www.ncbi.nlm.nih.gov/pubmed/40279629 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67298 %T Relationship Between Within-Session Digital Motor Skill Acquisition and Alzheimer Disease Risk Factors Among the MindCrowd Cohort: Cross-Sectional Descriptive Study %A Hooyman,Andrew %A Huentelman,Matt J %A De Both,Matt %A Ryan,Lee %A Duff,Kevin %A Schaefer,Sydney Y %K digital health technology %K web-based assessment %K aging %K APOE %K motor skills %K sensitivity %K risk factors %K adults %K older adults %D 2025 %7 24.4.2025 %9 %J JMIR Aging %G English %X Background: Previous research has shown that in-lab motor skill acquisition (supervised by an experimenter) is sensitive to biomarkers of Alzheimer disease (AD). However, remote unsupervised screening of AD risk through a skill-based task via the web has the potential to sample a wider and more diverse pool of individuals at scale. Objective: The purpose of this study was to examine a web-based motor skill game (“Super G”) and its sensitivity to risk factors of AD (eg, age, sex, APOE ε4 carrier status, and verbal learning deficits). Methods: Emails were sent to 662 previous MindCrowd participants who had agreed to be contacted for future research and have their APOE ε4 carrier status recorded and those who were at least 45 years of age or older. Participants who chose to participate were redirected to the Super G site where they completed the Super G task using their personal computer remotely and unsupervised. Once completed, different Super G variables were derived. Linear and logistic multivariable regression was used to examine the relationship between available AD risk factors (age, sex, APOE ε4 carrier status, and verbal learning) and distinct Super G performance metrics. Results: Fifty-four participants (~8% response rate) from the MindCrowd web-based cohort (mean age of 62.39 years; 39 females; and 23 APOE ε4 carriers) completed 75 trials of Super G. Results show that Super G performance was significantly associated with each of the targeted risk factors. Specifically, slower Super G response time was associated with being an APOE ε4 carrier (odds ratio 0.12, 95% CI 0.02-0.44; P=.006), greater Super G time in target (TinT) was associated with being male (odds ratio 32.03, 95% CI 3.74-1192,61; P=.01), and lower Super G TinT was associated with greater age (β −3.97, 95% CI −6.64 to −1.30; P=.005). Furthermore, a sex-by-TinT interaction demonstrated a differential relationship between Super G TinT and verbal learning depending on sex (βmale:TinT 6.77, 95% CI 0.34-13.19; P=.04). Conclusions: This experiment demonstrated that this web-based game, Super G, has the potential to be a skill-based digital biomarker for screening of AD risk on a large scale with relatively limited resources. %R 10.2196/67298 %U https://aging.jmir.org/2025/1/e67298 %U https://doi.org/10.2196/67298 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65183 %T Association Between Sleep Duration and Cognitive Frailty in Older Chinese Adults: Prospective Cohort Study %A Cai,Ruixue %A Chao,Jianqian %A Gao,Chenlu %A Gao,Lei %A Hu,Kun %A Li,Peng %K aging %K frailty %K cognition %K cohort study %K sleep duration %K sleep quality %K longitudinal study %D 2025 %7 23.4.2025 %9 %J JMIR Aging %G English %X Background: Disturbed sleep patterns are common among older adults and may contribute to cognitive and physical declines. However, evidence for the relationship between sleep duration and cognitive frailty, a concept combining physical frailty and cognitive impairment in older adults, is lacking. Objective: This study aimed to examine the associations of sleep duration and its changes with cognitive frailty. Methods: We analyzed data from the 2008‐2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was rendered based on the modified Fried frailty phenotype and Mini-Mental State Examination. Sleep duration was categorized as short (<6 h), moderate (6‐9 h), and long (>9 h). We examined the association of sleep duration with cognitive frailty status at baseline using logistic regressions and with the future incidence of cognitive frailty using Cox proportional hazards models. Restricted cubic splines were used to explore potential nonlinear associations. Results: Among 11,303 participants, 1298 (11.5%) had cognitive frailty at baseline. Compared to participants who had moderate sleep duration, the odds of having cognitive frailty were higher in those with long sleep duration (odds ratio 1.71, 95% CI 1.48‐1.97; P<.001). A J-shaped association between sleep duration and cognitive frailty was also observed (P<.001). Additionally, during a mean follow-up of 6.7 (SD 2.6) years among 5201 participants who were not cognitively frail at baseline, 521 (10%) participants developed cognitive frailty. A higher risk of cognitive frailty was observed in participants with long sleep duration (hazard ratio 1.32, 95% CI 1.07‐1.62; P=.008). Conclusions: Long sleep duration was associated with cognitive frailly in older Chinese adults. These findings provide insights into the relationship between sleep duration and cognitive frailty, with potential implications for public health policies and clinical practice. %R 10.2196/65183 %U https://aging.jmir.org/2025/1/e65183 %U https://doi.org/10.2196/65183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64853 %T Assessing Social Interaction and Loneliness and Their Association With Frailty Among Older Adults With Subjective Cognitive Decline or Mild Cognitive Impairment: Ecological Momentary Assessment Approach %A Kang,Bada %A Hong,Dahye %A Yoon,Seolah %A Kang,Chaeeun %A Kim,Jennifer Ivy %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 10 3279 2750, redyivy@gmail.com %K geriatric %K older %K elderly %K ageing %K association %K correlation %K cognitive impairment %K ecological momentary assessment %K frailty %K mild behavioral impairment %K dementia %K Alzheimer %K isolation %K lonely %K social %K interaction %K self-reported %K psychogeriatrics %D 2025 %7 22.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Frail older adults are at greater risk of adverse health-related outcomes such as falls, disability, and mortality. Mild behavioral impairment (MBI), which is characterized by neurobehavioral symptoms in individuals without dementia, is a crucial factor in identifying at-risk groups and implementing early interventions for frail older adults. However, the specific role of social functioning, which encompasses social interaction and loneliness levels, in relation to frailty within this group remains unclear. Objective: This study investigated the association between frailty status, social interaction frequency, and loneliness levels among older adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) while adjusting for MBI symptoms in 2 contexts: the presence and severity of MBI symptoms. Methods: Older adults with SCD or MCI were recruited from an outpatient clinic specializing in the early diagnosis and care management of dementia at a community health center, as well as from a community service center in Seoul, South Korea. Using an ecological momentary assessment approach, participants reported their daily social interaction frequency and loneliness level via a mobile app, 4 times daily for 2 weeks. Frailty status, the outcome variable, was assessed using the Korean version of the frailty phenotype questionnaire. Additionally, MBI symptoms were assessed using the 34-item MBI-Checklist covering 5 domains. Multinomial logistic regression analyses were performed to investigate the association between frailty status (robust, prefrail, and frail), and the independent variables, adjusting for the presence or severity of MBI symptoms. Results: Among the 101 participants analyzed, 29.7% (n=30) of participants were classified as prefrail, and 12.8% (n=13) of participants were classified as frail. Higher average daily social interaction scores were consistently associated with lower odds of a frail status compared to a robust status. This was evident in the models adjusted for both the global presence (relative risk ratio [RRR] 0.18, P=.02) and global severity (RRR 0.20, P=.02) of MBI symptoms. Conclusions: Frequent social interaction was inversely associated with frail status in older adults with SCD or MCI, even after adjusting for the presence and severity of MBI symptoms. These findings highlight the potential of social functioning as a modifiable factor for addressing frailty among older adults at risk of cognitive and functional decline. Future prospective studies using real-time measurements are needed to refine these findings and further investigate additional risk factors and functional outcomes in this group. %M 40210431 %R 10.2196/64853 %U https://mhealth.jmir.org/2025/1/e64853 %U https://doi.org/10.2196/64853 %U http://www.ncbi.nlm.nih.gov/pubmed/40210431 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e60866 %T Improved Alzheimer Disease Diagnosis With a Machine Learning Approach and Neuroimaging: Case Study Development %A Lazli,Lilia %K Alzheimer disease %K computer-aided diagnosis system %K machine learning %K principal component analysis %K linear discriminant analysis %K t-distributed stochastic neighbor embedding %K feedforward neural network %K vision transformer architecture %K support vector machines %K magnetic resonance imaging %K positron emission tomography imaging %K Open Access Series of Imaging Studies %K Alzheimer's Disease Neuroimaging Initiative %K OASIS %K ADNI %D 2025 %7 21.4.2025 %9 %J JMIRx Med %G English %X Background: Alzheimer disease (AD) is a severe neurological brain disorder. While not curable, earlier detection can help improve symptoms substantially. Machine learning (ML) models are popular and well suited for medical image processing tasks such as computer-aided diagnosis. These techniques can improve the process for an accurate diagnosis of AD. Objective: In this paper, a complete computer-aided diagnosis system for the diagnosis of AD has been presented. We investigate the performance of some of the most used ML techniques for AD detection and classification using neuroimages from the Open Access Series of Imaging Studies (OASIS) and Alzheimer’s Disease Neuroimaging Initiative (ADNI) datasets. Methods: The system uses artificial neural networks (ANNs) and support vector machines (SVMs) as classifiers, and dimensionality reduction techniques as feature extractors. To retrieve features from the neuroimages, we used principal component analysis (PCA), linear discriminant analysis, and t-distributed stochastic neighbor embedding. These features are fed into feedforward neural networks (FFNNs) and SVM-based ML classifiers. Furthermore, we applied the vision transformer (ViT)–based ANNs in conjunction with data augmentation to distinguish patients with AD from healthy controls. Results: Experiments were performed on magnetic resonance imaging and positron emission tomography scans. The OASIS dataset included a total of 300 patients, while the ADNI dataset included 231 patients. For OASIS, 90 (30%) patients were healthy and 210 (70%) were severely impaired by AD. Likewise for the ADNI database, a total of 149 (64.5%) patients with AD were detected and 82 (35.5%) patients were used as healthy controls. An important difference was established between healthy patients and patients with AD (P=.02). We examined the effectiveness of the three feature extractors and classifiers using 5-fold cross-validation and confusion matrix–based standard classification metrics, namely, accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve (AUROC). Compared with the state-of-the-art performing methods, the success rate was satisfactory for all the created ML models, but SVM and FFNN performed best with the PCA extractor, while the ViT classifier performed best with more data. The data augmentation/ViT approach worked better overall, achieving accuracies of 93.2% (sensitivity=87.2, specificity=90.5, precision=87.6, F1-score=88.7, and AUROC=92) for OASIS and 90.4% (sensitivity=85.4, specificity=88.6, precision=86.9, F1-score=88, and AUROC=90) for ADNI. Conclusions: Effective ML models using neuroimaging data could help physicians working on AD diagnosis and will assist them in prescribing timely treatment to patients with AD. Good results were obtained on the OASIS and ADNI datasets with all the proposed classifiers, namely, SVM, FFNN, and ViTs. However, the results show that the ViT model is much better at predicting AD than the other models when a sufficient amount of data are available to perform the training. This highlights that the data augmentation process could impact the overall performance of the ViT model. %R 10.2196/60866 %U https://xmed.jmir.org/2025/1/e60866 %U https://doi.org/10.2196/60866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56586 %T A Digital Photo Activity Intervention for Nursing Home Residents With Dementia and Their Carers: Mixed Methods Process Evaluation %A Tan,Josephine Rose Orejana %A Neal,David P %A Vilmen,Maria %A Boersma,Petra %A Ettema,Teake P %A Gobbens,Robbert J J %A Sikkes,Sietske A M %A Dröes,Rose-Marie %+ Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Oldenaller 1, Amsterdam, 1081 HJ, The Netherlands, 31 3316459170, j.r.tan@amsterdamumc.nl %K dementia %K psychosocial interventions %K nursing home %K process evaluation %K social interaction %K photos %K art %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Within the framework of a randomized controlled trial investigating the impact of a digital, psychosocial photo activity intervention for residents living with dementia in nursing homes and their informal and formal carers, a process evaluation was conducted to determine factors that affected the implementation of the intervention and potentially influenced the intervention outcomes. Objective: By tracing facilitators and barriers to implementation, the study also aimed to inform future implementation of the photo activity intervention. Methods: Following Medical Research Council guidance, mixed methods were used to investigate context, implementation, and mechanism-of-impact factors during the photo activity intervention via the Fotoscope web application versus a general conversation activity (control). Google Analytics was set up to gain insight into how the Fotoscope web application was used in practice. For quantitative data, descriptive statistics were calculated and differences between groups tested. For qualitative data, thematic analysis was performed. Results: In total, 163 semistructured interviews were conducted with residents (photo activity group: n=29, 17.8%; control: n=29, 17.8%), formal carers (photo activity group: n=23, 14.1%; control: n=27, 16.6%), and informal carers (photo activity group: n=28, 17.2%; control: n=27, 16.6%). Regarding contextual factors, a minority of formal carers in both groups (photo activity group: 4/18, 22%; control: 9/24, 38%) mentioned time and workload as barriers to implementing the intervention. Regarding implementation, 86% (25/29) of the residents in the intervention group felt that the digital photo activity worked well on a tablet. Informal carers from both groups wanted more intervention updates from formal carers. The majority of formal carers from both groups were satisfied with how the training and activities were implemented. Regarding the mechanisms of impact, residents in the photo activity group (27/29, 93%) felt significantly more positive about the conversations with their carer (U=533.0, z=2.865, r=0.39; P=.004). Formal carers in the photo activity group (20/23, 87%) got to know the resident better (U=390.5, z=2.114, r=0.302; P=.04) compared to the formal carers in the control group (21/27, 78%). Formal carers in the photo activity group (23/50, 46%) gave a significantly higher rating to the digital photo activity as a way of getting to know the resident living with dementia better (median 9.00, IQR 7-9; U=419.0, z=2.169, r=0.307; P=.03) compared to formal carers in the control group (27/50, 54%; median 8.00, IQR 6-8). Finally, the majority of formal carers in the photo activity group (14/18, 78%) agreed that the Fotoscope app can be used as part of care activities in the nursing home. Conclusions: The work invested by formal carers in implementing the photo activity did not seem to differ greatly compared to implementing a general conversation activity, suggesting that the digital photo activity, as an easy-to-implement and enjoyable intervention, could be widely implemented and disseminated in nursing homes. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s12877-021-02632-w %M 40239200 %R 10.2196/56586 %U https://formative.jmir.org/2025/1/e56586 %U https://doi.org/10.2196/56586 %U http://www.ncbi.nlm.nih.gov/pubmed/40239200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67755 %T Impact of a Virtual Reality Video ("A Walk-Through Dementia") on YouTube Users: Topic Modeling Analysis %A Li,Xiaoli %A Liu,Xiaoyu %A Yin,Cheng %A Collins,Sandra %A Alanazi,Eman %K Alzheimer disease %K Alzheimer disease and related dementias %K ADRD %K dementia %K public awareness %K text mining %K older adult %K health care student %K training %K health care professional %K simulation %K digital world %K virtual environment %K virtual tour %K walk-through dementia %K virtual reality %K VR %K VR video %K VR application %K topic modeling %K YouTube %K Bidirectional Encoder Representations from Transformers %K BERT %K social media comments %K experiential learning tool %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Emerging research has highlighted the potential of virtual reality (VR) as a tool for training health care students and professionals in care skills for individuals with Alzheimer disease and related dementias (ADRD). However, there is limited research on the use of VR to engage the general public in raising awareness about ADRD. Objective: This research aimed to examine the impact of the VR video “A Walk-Through Dementia” on YouTube users by analyzing their posts. Methods: We collected 12,754 comments from the VR video series “A Walk-Through Dementia,” which simulates the everyday challenges faced by individuals with ADRD, providing viewers with an immersive experience of the condition. Topic modeling was conducted to gauge viewer opinions and reactions to the videos. A pretrained Bidirectional Encoder Representations from Transformers (BERT) model was used to transform the YouTube comments into high-dimensional vector embeddings, allowing for systematic identification and detailed analysis of the principal topics and their thematic structures within the dataset. Results: We identified the top 300 most frequent words in the dataset and categorized them into nouns, verbs, and adjectives or adverbs using a part-of-speech tagging model, fine-tuned for accurate tagging tasks. The topic modeling process identified eight8 initial topics based on the most frequent words. After manually reviewing the 8 topics and the content of the comments, we synthesized them into 5 themes. The predominant theme, represented in 2917 comments, centered on users’ personal experiences with the impact of ADRD on patients and caregivers. The remaining themes were categorized into 4 main areas: positive reactions to the VR videos, challenges faced by individuals with ADRD, the role of caregivers, and learning from the VR videos. Conclusions: Using topic modeling, this study demonstrated that VR applications serve as engaging and experiential learning tools, offering the public a deeper understanding of life with ADRD. Future research should explore additional VR applications on social media, as they hold the potential to reach wider audiences and effectively disseminate knowledge about ADRD. %R 10.2196/67755 %U https://formative.jmir.org/2025/1/e67755 %U https://doi.org/10.2196/67755 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64324 %T Patient-Related Barriers to Digital Technology Adoption in Alzheimer Disease: Systematic Review %A Panzavolta,Andrea %A Arighi,Andrea %A Guido,Emanuele %A Lavorgna,Luigi %A Di Lorenzo,Francesco %A Dodich,Alessandra %A Cerami,Chiara %K digital technology %K digital e-health %K accessibility %K user-friendliness %K neurocognitive disorders %K Alzheimer disease %K dementia %D 2025 %7 10.4.2025 %9 %J JMIR Aging %G English %X Background: Digital technology in dementia is an area of great development with varying experiences across countries. However, novel digital solutions often lack a patient-oriented perspective, and several relevant barriers prevent their use in clinics. Objective: In this study, we reviewed the existing literature on knowledge, familiarity, and competence in using digital technology and on attitude and experiences with digital tools in Alzheimer disease. The main research question is whether digital competence and attitudes of patients and caregivers may affect the adoption of digital technology. Methods: Following the PRISMA guidelines, a literature search was conducted by two researchers in the group. Inter-rater reliability was calculated with Cohen κ statistics. The risk of bias assessment was also recorded. Results: Of 597 initial records, only 18 papers were considered eligible. Analyses of inter-rater reliability showed good agreement levels. Significant heterogeneity in study design, sample features, and measurement tools emerged across studies. Quality assessment showed a middle-high overall quality of evidence. The main factors affecting the adoption of digital technology in patients and caregivers are severity of cognitive deficits, timing of adoption, and the availability of training and support. Additional factors are age, type of digital device, and ease of use of the digital solution. Conclusions: Adoption of digital technology in dementia is hampered by many patient-related barriers. Improving digital competence in patient-caregiver dyads and implementing systematic, patient-oriented strategies for the development and use of digital tools are needed for a successful incorporation of digital technology in memory clinics. %R 10.2196/64324 %U https://aging.jmir.org/2025/1/e64324 %U https://doi.org/10.2196/64324 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69952 %T Longitudinal and Combined Smartwatch and Ecological Momentary Assessment in Racially Diverse Older Adults: Feasibility, Adherence, and Acceptability Study %A Holmqvist,Sophia %A Kaplan,Marina %A Chaturvedi,Riya %A Shou,Haochang %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N. 13th St, Philadelphia, PA, 19122, United States, 1 215 204 7000, sophia.holmqvist@temple.edu %K cognitive impairment %K smartwatch %K longitudinal monitoring %K ecological momentary assessment %K aging %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Due to the rising prevalence of Alzheimer disease and related dementias, easily deployable tools to quantify risk are needed. Smartphones and smartwatches enable unobtrusive and continuous monitoring, but there is limited information regarding the feasibility, adherence, and acceptability of digital data collection among racially diverse older adults. Objective: This paper examined the feasibility, adherence, and acceptability of a 4-week combined smartwatch monitoring and ecological momentary assessment (EMA) study in a racially diverse sample of older adults. Methods: A total of 44 older adults (aged ≥55 y) with either mild cognitive impairment or healthy cognition completed an informed consent comprehension quiz, baseline cognitive testing, training regarding digital data collection, and questionnaires. Participants were instructed to wear a Garmin Vivosmart 4 smartwatch for 23 h/d for 4 weeks, sync 2 smartphone apps (Garmin and Labfront) daily, and complete a daily EMA survey with automated prompts for surveys and charging. Training time, smartwatch adherence (eg, wear time), daily EMA survey response rate, and performance on the consent quiz were quantified. Associations between feasibility and adherence metrics and participant factors were evaluated. Self-reported usability of the apps and smartwatch was collected at study end. Results: Consent comprehension quiz scores were high (mean 97.33%, SD 6.86% correct), and training sessions lasted on average 17.93 (SD 6.89) minutes. During the 4-week study, participants wore the smartwatch for an average of 21 h/d (SD 1.53) and showed an average response rate of 94% (SD 9.58%) to daily EMA surveys. In unadjusted bivariate analyses, age, race, and cognition were associated with feasibility and adherence measures, but only age and race remained significant in multivariate models. After accounting for all participant factors, older age was a significant predictor of longer training time, and Black race was a significant predictor of lower daily wear time. On the usability survey, all participants (45/45, 100%) indicated willingness to participate in future smartwatch studies, >80% (37/45) had a positive experience, and >90% (41/45) were satisfied with smartphone app syncing. Conclusions: Smartwatch monitoring, requiring daily wear, smartphone syncing, and daily EMA survey completion, is highly feasible in older adults because adherence to daily wear and EMA surveys was high, as was general satisfaction on usability surveys. Although older participants may require more training on smartwatch and smartphone procedures and automated prompting during the study period, longitudinal monitoring with the Garmin Vivosmart 4 smartwatch and Labfront app is acceptable and feasible for collecting nearly continuous data in Black and White older adults, including those with mild cognitive impairment and those without. %M 40198914 %R 10.2196/69952 %U https://humanfactors.jmir.org/2025/1/e69952 %U https://doi.org/10.2196/69952 %U http://www.ncbi.nlm.nih.gov/pubmed/40198914 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e59942 %T Identifying Unmet Needs of Informal Dementia Caregivers in Clinical Practice: User-Centered Development of a Digital Assessment Tool %A Biernetzky,Olga A %A Thyrian,Jochen René %A Boekholt,Melanie %A Berndt,Matthias %A Hoffmann,Wolfgang %A Teipel,Stefan J %A Kilimann,Ingo %K unmet needs %K assessment development %K family caregivers of people with dementia %K dementia %K need %K Alzheimer %K self-guided %K self-reported %K caregiver %K informal care %K spousal care %K interview %K qualitative %K thematic %K usability %K mHealth %K tablet %K self-completed %K aging %K patient care %K health interventions %K care giver %K digital health %K ehealth %K digital assessment %K memory %D 2025 %7 7.4.2025 %9 %J JMIR Aging %G English %X Background: Despite the increasing interventions to support family caregivers of people with dementia, service planning and delivery is still not effective. Objective: Our study aimed to develop a digitally-supported needs assessment tool for family caregivers of people with dementia that is feasible, time-efficient, understood by users, and can be self-completed in the primary care setting. Methods: The development of the unmet needs assessment tool was part of a cluster-randomized controlled trial examining the effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia (GAIN [Gesund Angehörige Pflegen]) and was conducted in 3 phases. Using an iterative participatory approach with informal caregivers, health care professionals including general practitioners, neurologists, psychologists, psychiatrists, nurses, and Alzheimer Society representatives, we developed a digital self-completion unmet needs assessment tool focusing on informal caregivers’ biopsychosocial health und quality of life in connection to their caregiver responsibilities. Data were collected through group discussions, written feedback, protocols, think-aloud protocols, and interviews, and analyzed thematically. Results: Data from 27 caregivers, including caregivers of people with dementia (n=18), health care professionals (n=7), and Alzheimer Society representatives (n=2) were collected. Thematic analysis identified 2 main themes: content of the assessment tool and usability and handling of the digital tablet-based assessment tool. The feedback provided by the stakeholders led to new aspects and changes to make the tool comprehensive, easy to read, and easy to handle. The overall mean completion time was reduced from the initial 37 minutes to 18 minutes, which renders the assessment tool fit to be self-completed in waiting rooms of primary care practices or other settings. Conclusions: The input of the 3 stakeholder groups has supported the development of the assessment tool ensuring that all aspects considered important were covered and understood and the completion of the assessment procedure was time-efficient and practically feasible. Further validation of the assessment tool will be performed with the data generated as part of the GAIN trial. Trial Registration: ClinicalTrials.gov NCT04037501; https://clinicaltrials.gov/study/NCT04037501 %R 10.2196/59942 %U https://aging.jmir.org/2025/1/e59942 %U https://doi.org/10.2196/59942 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67294 %T Detecting Sleep/Wake Rhythm Disruption Related to Cognition in Older Adults With and Without Mild Cognitive Impairment Using the myRhythmWatch Platform: Feasibility and Correlation Study %A Jones,Caleb D %A Wasilko,Rachel %A Zhang,Gehui %A Stone,Katie L %A Gujral,Swathi %A Rodakowski,Juleen %A Smagula,Stephen F %K sleep %K sleep/wake %K circadian %K activity pattern %K dementia %K cognition %K mobile sensing %K actigraphy %K accelerometer %D 2025 %7 7.4.2025 %9 %J JMIR Aging %G English %X Background: Consumer wearable devices could, in theory, provide sufficient accelerometer data for measuring the 24-hour sleep/wake risk factors for dementia that have been identified in prior research. To our knowledge, no prior study in older adults has demonstrated the feasibility and acceptability of accessing sufficient consumer wearable accelerometer data to compute 24-hour sleep/wake rhythm measures. Objective: We aimed to establish the feasibility of characterizing 24-hour sleep/wake rhythm measures using accelerometer data gathered from the Apple Watch in older adults with and without mild cognitive impairment (MCI), and to examine correlations of these sleep/wake rhythm measures with neuropsychological test performance. Methods: Of the 40 adults enrolled (mean [SD] age 67.2 [8.4] years; 72.5% female), 19 had MCI and 21 had no cognitive disorder (NCD). Participants were provided devices, oriented to the study software (myRhythmWatch or myRW), and asked to use the system for a week. The primary feasibility outcome was whether participants collected enough data to assess 24-hour sleep/wake rhythm measures (ie, ≥3 valid continuous days). We extracted standard nonparametric and extended-cosine based sleep/wake rhythm metrics. Neuropsychological tests gauged immediate and delayed memory (Hopkins Verbal Learning Test) as well as processing speed and set-shifting (Oral Trails Parts A and B). Results: All participants meet the primary feasibility outcome of providing sufficient data (≥3 valid days) for sleep/wake rhythm measures. The mean (SD) recording length was somewhat shorter in the MCI group at 6.6 (1.2) days compared with the NCD group at 7.2 (0.6) days. Later activity onset times were associated with worse delayed memory performance (β=−.28). More fragmented rhythms were associated with worse processing speed (β=.40). Conclusions: Using the Apple Watch-based myRW system to gather raw accelerometer data is feasible in older adults with and without MCI. Sleep/wake rhythms variables generated from this system correlated with cognitive function, suggesting future studies can use this approach to evaluate novel, scalable, risk factor characterization and targeted therapy approaches. %R 10.2196/67294 %U https://aging.jmir.org/2025/1/e67294 %U https://doi.org/10.2196/67294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68454 %T Clinical Benefits and Risks of Antiamyloid Antibodies in Sporadic Alzheimer Disease: Systematic Review and Network Meta-Analysis With a Web Application %A Jeremic,Danko %A Navarro-Lopez,Juan D %A Jimenez-Diaz,Lydia %+ Neurophysiology & Behavior Lab, Institute of Biomedicine (IB-UCLM) and Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Camino Moledores s/n, Ciudad Real, 13071, Spain, 34 926295300, lydia.jimenez@uclm.es %K Alzheimer disease %K antibodies %K donanemab %K aducanumab %K lecanemab %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Despite the increasing approval of antiamyloid antibodies for Alzheimer disease (AD), their clinical relevance and risk-benefit profile remain uncertain. The heterogeneity of AD and the limited availability of long-term clinical data make it difficult to establish a clear rationale for selecting one treatment over another. Objective: The aim of this work was to assess and compare the efficacy and safety of antiamyloid antibodies through an interactive online meta-analytic approach by performing conventional pair-wise meta-analyses and frequentist and Bayesian network meta-analyses of phase II and III clinical trial results. To achieve this, we developed AlzMeta.app 2.0, a freely accessible web application that enables researchers and clinicians to evaluate the relative and absolute risks and benefits of these therapies in real time, incorporating different prior choices and assumptions of baseline risks of disease progression and adverse events. Methods: We adhered to PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for reporting of systematic reviews with network meta-analysis) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines for reporting and rating the certainty of evidence. Clinical trial reports (until September 30, 2024) were retrieved from PubMed, Google Scholar, and clinical trial databases (including ClinicalTrials.gov). Studies with <20 sporadic AD patients and a modified Jadad score <3 were excluded. Risk of bias was assessed with the RoB-2 tool. Relative risks and benefits have been expressed as risk ratios and standardized mean differences, with confidence, credible, and prediction intervals calculated for all outcomes. For significant results, the intervention effects were ranked in frequentist and Bayesian frameworks, and their clinical relevance was determined by the absolute risk per 1000 people and number needed to treat (NNT) for a wide range of control responses. Results: Among 7 treatments tested in 21,236 patients (26 studies with low risk of bias or with some concerns), donanemab was the best-ranked treatment on cognitive and functional measures, and it was almost 2 times more effective than aducanumab and lecanemab and significantly more beneficial than other treatments on the global (cognitive and functional) Clinical Dementia Rating Scale-Sum of Boxes (NNT=10, 95% CI 8-16). Special caution is required regarding cerebral edema and microbleeding due to the clinically relevant risks of edema for donanemab (NNT=8, 95% CI 5-16), aducanumab (NNT=10, 95% CI 6-17), and lecanemab (NNT=14, 95% CI 7-31), which may outweigh the benefits. Conclusions: Our results showed that donanemab is more effective and has a safety profile similar to aducanumab and lecanemab, highlighting the need for treatment options with improved safety. Potential bias may have been introduced in the included trials due to unblinding caused by frequent cerebral edema and microbleeds, as well as the impact of the COVID-19 pandemic. %M 40194268 %R 10.2196/68454 %U https://www.jmir.org/2025/1/e68454 %U https://doi.org/10.2196/68454 %U http://www.ncbi.nlm.nih.gov/pubmed/40194268 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60471 %T Improving Early Dementia Detection Among Diverse Older Adults With Cognitive Concerns With the 5-Cog Paradigm: Protocol for a Hybrid Effectiveness-Implementation Clinical Trial %A Chalmer,Rachel Beth Rosansky %A Ayers,Emmeline %A Weiss,Erica F %A Fowler,Nicole R %A Telzak,Andrew %A Summanwar,Diana %A Zwerling,Jessica %A Wang,Cuiling %A Xu,Huiping %A Holden,Richard J %A Fiori,Kevin %A French,Dustin D %A Nsubayi,Celeste %A Ansari,Asif %A Dexter,Paul %A Higbie,Anna %A Yadav,Pratibha %A Walker,James M %A Congivaram,Harrshavasan %A Adhikari,Dristi %A Melecio-Vazquez,Mairim %A Boustani,Malaz %A Verghese,Joe %+ Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, 10467-2401, United States, 1 718 920 6722, rchalmer@montefiore.org %K cognitive assessment %K cognitive screening %K cognitive impairment %K mild cognitive impairment %K dementia %K dissemination and implementation science %K clinical trial protocol %K randomized controlled trial %K hybrid implementation-effectiveness trial %D 2025 %7 3.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The 5-Cog paradigm is a 5-minute brief cognitive assessment coupled with a clinical decision support tool designed to improve clinicians’ early detection of cognitive impairment, including dementia, in their diverse older primary care patients. The 5-Cog battery uses picture- and symbol-based assessments and a questionnaire. It is low cost, simple, minimizes literacy bias, and is culturally fair. The decision support component of the paradigm helps nudge appropriate care provider response to an abnormal 5-Cog battery. Objective: The objective of our study is to evaluate the effectiveness, implementation, and cost of the 5-Cog paradigm. Methods: We will enroll 6600 older patients with cognitive concerns from 22 primary care clinics in the Bronx, New York, and in multiple locations in Indiana for this hybrid type 1 effectiveness-implementation trial. We will analyze the effectiveness of the 5-Cog paradigm to increase the rate of new diagnoses of mild cognitive impairment syndrome or dementia using a pragmatic, cluster randomized clinical trial design. The secondary outcome is the ordering of new tests, treatments, and referrals for cognitive indications within 90 days after the study visit. The 5-Cog’s decision support component will be deployed as an electronic medical record feature. We will analyze the 5-Cog’s implementation process, context, and outcomes through the Consolidated Framework for Implementation Research using a mixed methods design (surveys and interviews). The study will also examine cost-effectiveness from societal and payer (Medicare) perspectives by estimating the cost per additional dementia diagnosis. Results: The study is funded by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (2U01NS105565). The protocol was approved by the Albert Einstein College of Medicine Institutional Review Board in September 2022. A validation study was completed to select cut scores for the 5-Cog battery. Among the 76 patients enrolled, the resulting clinical diagnoses were as follows: dementia in 32 (42%); mild cognitive impairment in 28 (37%); subjective cognitive concerns without objective cognitive impairment in 12 (16%); no cognitive diagnosis assigned in 2 (3%). The mean scores were Picture-Based Memory Impairment Screen 5.8 (SD 2.7), Symbol Match 27.2 (SD 18.2), and Subjective Motoric Cognitive Risk 2.4 (SD 1.7). The cut scores for an abnormal or positive result on the 5-Cog components were as follows: Picture-Based Memory Impairment Screen ≤6 (range 0-8), Symbol Match ≤25 (range 0-65), and Subjective Motoric Cognitive Risk >5 (range 0-7). As of December 2024, a total of 12 clinics had completed the onboarding processes, and 2369 patients had been enrolled. Conclusions: The findings of this study will facilitate the rapid adaptation and dissemination of this effective and practical clinical tool across diverse primary care clinical settings. Trial Registration: ClinicalTrials.gov NCT05515224; https://www.clinicaltrials.gov/study/NCT05515224 International Registered Report Identifier (IRRID): DERR1-10.2196/60471 %M 40179383 %R 10.2196/60471 %U https://www.researchprotocols.org/2025/1/e60471 %U https://doi.org/10.2196/60471 %U http://www.ncbi.nlm.nih.gov/pubmed/40179383 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59520 %T Development and Validation of a Machine Learning Model for Early Prediction of Delirium in Intensive Care Units Using Continuous Physiological Data: Retrospective Study %A Park,Chanmin %A Han,Changho %A Jang,Su Kyeong %A Kim,Hyungjun %A Kim,Sora %A Kang,Byung Hee %A Jung,Kyoungwon %A Yoon,Dukyong %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 31 5189 8450, dukyong.yoon@yonsei.ac.kr %K delirium %K intensive care unit %K machine learning %K prediction model %K early prediction %D 2025 %7 2.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Delirium in intensive care unit (ICU) patients poses a significant challenge, affecting patient outcomes and health care efficiency. Developing an accurate, real-time prediction model for delirium represents an advancement in critical care, addressing needs for timely intervention and resource optimization in ICUs. Objective: We aimed to create a novel machine learning model for delirium prediction in ICU patients using only continuous physiological data. Methods: We developed models integrating routinely available clinical data, such as age, sex, and patient monitoring device outputs, to ensure practicality and adaptability in diverse clinical settings. To confirm the reliability of delirium determination records, we prospectively collected results of Confusion Assessment Method for the ICU (CAM-ICU) evaluations performed by qualified investigators from May 17, 2021, to December 23, 2022, determining Cohen κ coefficients. Participants were included in the study if they were aged ≥18 years at ICU admission, had delirium evaluations using the CAM-ICU, and had data collected for at least 4 hours before delirium diagnosis or nondiagnosis. The development cohort from Yongin Severance Hospital (March 1, 2020, to January 12, 2022) comprised 5478 records: 5129 (93.62%) records from 651 patients for training and 349 (6.37%) records from 163 patients for internal validation. For temporal validation, we used 4438 records from the same hospital (January 28, 2022, to December 31, 2022) to reflect potential seasonal variations. External validation was performed using data from 670 patients at Ajou University Hospital (March 2022 to September 2022). We evaluated machine learning algorithms (random forest [RF], extra-trees classifier, and light gradient boosting machine) and selected the RF model as the final model based on its performance. To confirm clinical utility, a decision curve analysis and temporal pattern for model prediction during the ICU stay were performed. Results: The κ coefficient between labels generated by ICU nurses and prospectively verified by qualified researchers was 0.81, indicating reliable CAM-ICU results. Our final model showed robust performance in internal validation (area under the receiver operating characteristic curve [AUROC]: 0.82; area under the precision-recall curve [AUPRC]: 0.62) and maintained its accuracy in temporal validation (AUROC: 0.73; AUPRC: 0.85). External validation supported its effectiveness (AUROC: 0.84; AUPRC: 0.77). Decision curve analysis showed a positive net benefit at all thresholds, and the temporal pattern analysis showed a gradual increase in the model scores as the actual delirium diagnosis time approached. Conclusions: We developed a machine learning model for delirium prediction in ICU patients using routinely measured variables, including physiological waveforms. Our study demonstrates the potential of the RF model in predicting delirium, with consistent performance across various validation scenarios. The model uses noninvasive variables, making it applicable to a wide range of ICU patients, with minimal additional risk. %M 40173433 %R 10.2196/59520 %U https://www.jmir.org/2025/1/e59520 %U https://doi.org/10.2196/59520 %U http://www.ncbi.nlm.nih.gov/pubmed/40173433 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e66167 %T Digital Ergonomics of NavegApp, a Novel Serious Game for Spatial Cognition Assessment: Content Validity and Usability Study %A Sanchez-Escudero,Juan Pablo %A Aguillon,David %A Valencia,Stella %A Garcia-Barrera,Mauricio A %A Aguirre-Acevedo,Daniel Camilo %A Trujillo,Natalia %+ Group of Epidemiology, Universidad de Antioquia, Calle 70 No. 52-21, Medellín, Colombia, 57 6042198332, juanp.sanchez@udea.edu.co %K serious games %K spatial cognition %K digital neuropsychology %K Alzheimer disease %K content validity %K usability %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD. Objective: This study aimed to determine the content validity and usability perception of NavegApp across multiple groups of interest. Methods: A multistep process integrating methodologies from software engineering, psychometrics, and health measurement was implemented to validate the software. Our approach was structured into 3 stages, guided by the software life cycle for health and the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations for evaluating the psychometric quality of health instruments. To assess content validity, a panel of 8 experts evaluated the relevance and representativeness of tasks included in the app. In addition, 212 participants, categorized into 5 groups based on their clinical status and risk level for AD, were recruited to evaluate the app’s digital ergonomics and usability at various stages of development. Complementary analyses were performed to identify group differences and to explore the association between task difficulty and user agreeableness. Results: NavegApp was validated as a highly usable tool by both experts and users. The expert panel confirmed that the tasks included in the game were representative (Aiken V=0.96-1.00) and relevant (Aiken V=0.96-1.00) for measuring SC components. Both experts and nonexperts rated NavegApp’s digital ergonomics positively, with minimal differences between groups (rrb 0.08-0.29). Differences in usability perceptions were observed among participants with sporadic mild cognitive impairment compared to cognitively healthy individuals (rrb 0.26-0.29). A moderate association was also identified between task difficulty and user agreeableness (Cramér V=0.37, 95% CI 0.28-0.54). Conclusions: NavegApp is a valid and user-friendly SG designed for SC assessment, developed by integrating software engineering and psychometric evaluation methodologies. While the results are promising, further studies are warranted to evaluate its diagnostic accuracy and construct validity. This work outlines a comprehensive framework for SG development in cognitive assessment, emphasizing the importance of incorporating psychometric validity measures from the outset of the design process. %M 40173437 %R 10.2196/66167 %U https://games.jmir.org/2025/1/e66167 %U https://doi.org/10.2196/66167 %U http://www.ncbi.nlm.nih.gov/pubmed/40173437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67545 %T Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial %A Han,Areum %A Oster,Robert %A Yuen,Hon %A Jenkins,Jeremy %A Hawkins,Jessica %A Edwards,Lauren %+ , Department of Occupational Therapy, University of Alabama at Birmingham, SHPB 339, 1720 2nd Avenue South, Birmingham, AL, 35294, United States, 1 2059752882, ahan@uab.edu %K acceptance and commitment therapy %K Alzheimer disease %K caregivers %K dementia %K depression %K web-based intervention %K quality of life %K randomized controlled trial %K stress %K videoconferencing %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers’ mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population. Objective: This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only. Methods: This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes. Results: The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of –6.09 (1.16) points (95% CI –8.42 to –3.76; P<.001) in the posttest and –6.71 (1.45) points (95% CI –9.63 to –3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032). Conclusions: The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among family caregivers with depression who give care to individuals with dementia. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs. Trial Registration: ClinicalTrials.gov NCT05043441; https://clinicaltrials.gov/study/NCT05043441 %M 40163859 %R 10.2196/67545 %U https://formative.jmir.org/2025/1/e67545 %U https://doi.org/10.2196/67545 %U http://www.ncbi.nlm.nih.gov/pubmed/40163859 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65178 %T Unsupervised Deep Learning of Electronic Health Records to Characterize Heterogeneity Across Alzheimer Disease and Related Dementias: Cross-Sectional Study %A West,Matthew %A Cheng,You %A He,Yingnan %A Leng,Yu %A Magdamo,Colin %A Hyman,Bradley T %A Dickson,John R %A Serrano-Pozo,Alberto %A Blacker,Deborah %A Das,Sudeshna %+ Massachusetts General Hospital, 65 Landsdowne Street, Cambridge, MA, 02139, United States, 1 617 768 8254, sdas5@mgh.harvard.edu %K Alzheimer disease and related dementias %K electronic health records %K large language models %K clustering %K unsupervised learning %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (ADRD) exhibit prominent heterogeneity. Identifying clinically meaningful ADRD subtypes is essential for tailoring treatments to specific patient phenotypes. Objective: We aimed to use unsupervised learning techniques on electronic health records (EHRs) from memory clinic patients to identify ADRD subtypes. Methods: We used pretrained embeddings of non-ADRD diagnosis codes (International Classification of Diseases, Ninth Revision) and large language model (LLM)–derived embeddings of clinical notes from patient EHRs. Hierarchical clustering of these embeddings was used to identify ADRD subtypes. Clusters were characterized regarding their demographic and clinical features. Results: We analyzed a cohort of 3454 patients with ADRD from a memory clinic at Massachusetts General Hospital, each with a specialist diagnosis. Clustering pretrained embeddings of the non-ADRD diagnosis codes in patient EHRs revealed the following 3 patient subtypes: one with skin conditions, another with psychiatric disorders and an earlier age of onset, and a third with diabetes complications. Similarly, using LLM-derived embeddings of clinical notes, we identified 3 subtypes of patients as follows: one with psychiatric manifestations and higher prevalence of female participants (prevalence ratio: 1.59), another with cardiovascular and motor problems and higher prevalence of male participants (prevalence ratio: 1.75), and a third one with geriatric health disorders. Notably, we observed significant overlap between clusters from both data modalities (χ24=89.4; P<.001). Conclusions: By integrating International Classification of Diseases, Ninth Revision codes and LLM-derived embeddings, our analysis delineated 2 distinct ADRD subtypes with sex-specific comorbid and clinical presentations, offering insights for potential precision medicine approaches. %R 10.2196/65178 %U https://aging.jmir.org/2025/1/e65178 %U https://doi.org/10.2196/65178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59649 %T The Role of Machine Learning in Cognitive Impairment in Parkinson Disease: Systematic Review and Meta-Analysis %A Wu,Yanyun %A Cheng,Yangfan %A Xiao,Yi %A Shang,Huifang %A Ou,Ruwei %+ Department of Neurology, West China Hospital of Sichuan University, No.37, Guoxue Lane, Chengdu, 610041, China, 86 18980607525, ouruwei@aliyun.com %K Parkinson disease %K cognitive impairment %K machine learning %K systematic review %K meta-analysis %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a common neurodegenerative disease characterized by both motor and nonmotor symptoms. Cognitive impairment often occurs early in the disease and can persist throughout its progression, severely impacting patients’ quality of life. The utilization of machine learning (ML) has recently shown promise in identifying cognitive impairment in patients with PD. Objective: This study aims to summarize different ML models applied to cognitive impairment in patients with PD and to identify determinants for improving diagnosis and predictive power for early detection of cognitive impairment. Methods: PubMed, Cochrane, Embase, and Web of Science were searched for relevant articles on March 2, 2024. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Bivariate meta-analysis was used to estimate pooled sensitivity and specificity results, presented as odds ratio (OR) and 95% CI. A summary receiver operator characteristic (SROC) curve was used. Results: A total of 38 articles met the criteria, involving 8564 patients with PD and 1134 healthy controls. Overall, 120 models reported sensitivity and specificity, with mean values of 71.07% (SD 13.72%) and 77.01% (SD 14.31%), respectively. Predictors commonly used in ML models included clinical features, neuroimaging features, and other variables. No significant heterogeneity was observed in the bivariate meta-analysis, which included 12 studies. Using sensitivity as the metric, the combined sensitivity and specificity were 0.76 (95% CI 0.67-0.83) and 0.83 (95% CI 0.76-0.88), respectively. When specificity was used, the combined values were 0.77 (95% CI 0.65-0.86) and 0.76 (95% CI 0.63-0.85), respectively. The area under the curves of the SROC were 0.87 (95% CI 0.83-0.89) and 0.83 (95% CI 0.80-0.86) respectively. Conclusions: Our findings provide a comprehensive summary of various ML models and demonstrate the effectiveness of ML as a tool for diagnosing and predicting cognitive impairment in patients with PD. Trial Registration: PROSPERO CRD42023480196; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023480196 %M 40153789 %R 10.2196/59649 %U https://www.jmir.org/2025/1/e59649/ %U https://doi.org/10.2196/59649 %U http://www.ncbi.nlm.nih.gov/pubmed/40153789 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66975 %T Stress and Hypertension Among African American Female Family Caregivers of Persons Living With Alzheimer Disease and Related Dementias: Protocol for a Pilot Internet-Based Randomized Controlled Trial %A Wright,Kathy D %A Richards Adams,Ingrid K %A Helsabeck,Nathan P %A Rose,Karen M %A Moss,Karen O %A Nemati,Donya %A Palmer,Navia %A Kim,Bohyun %A Pokhrel Bhattarai,Sunita %A Nguyen,Christopher %A Addison,Daniel %A Klatt,Maryanna D %+ The Ohio State University College of Nursing, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6142920309, wright.2104@osu.edu %K African American women %K high blood pressure %K stress reactivity and resilience %K caregiving %K hypertension %K stress %K Alzheimer disease %K dementia %K lifestyle and healthy self-care behaviors %D 2025 %7 27.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caregivers of persons with Alzheimer disease and related dementias (ADRD) neglect their health, including by ignoring stress levels. African American women are vulnerable and susceptible to hypertension. Chronic caregiving stress and hypertension place them at high risk for cardiovascular disease. Addressing stress reactivity or resilience is vital in lessening their caregiving stress, enhancing their quality of life (QOL), and fostering healthy blood pressure (BP) self-care behaviors. Objective: This pilot study aims to investigate the feasibility and acceptability of implementing the Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH) intervention in this population and to evaluate its effect on ADRD caregivers’ stress and QOL. Additionally, it explores the mediation of stress reactivity or resilience between interventions and self-care behaviors. Methods: A small randomized controlled trial pilot study will recruit 28 African American or Black female caregivers aged 40 years diagnosed with hypertension and on an antihypertensive medication. Participants will be randomly assigned to either the MIM DASH or the Alzheimer’s Association caregiver training group (attention control). Trained facilitators will deliver both interventions over 8 weeks through 1-hour, group, internet-based sessions, via video or telephone. After completion, both groups will receive coaching calls over 9 months, beginning with 8 weekly calls followed by 4 monthly calls to encourage use of the educational materials. Primary outcome measures include feasibility (recruitment and retention) and acceptability (attendance). Secondary measures assess caregiver stress (Perceived Stress Scale), QOL, and self-care behaviors (Food Frequency Questionnaire and self-reported physical activity). Data collection occurs at baseline, 3 months, and 9 months. Quantitative data will be analyzed using descriptive statistics, CIs, and mediation models. Results: This study was approved by the institutional review board in April 2022 and funded in May 2022. The first data were collected in January 2023, and the last data were collected in September 2024. The completion of all aims’ data analysis is anticipated in spring 2025. The participants’ mean age was 62.4 (SD 7.98) years, with a mean baseline systolic BP of 128 (SD 19) mm Hg and diastolic BP of 79 (SD 10) mm Hg. Participants reported that MIM DASH was acceptable (at a mean score of 59.08, SD 7.38, compared to 60.83, SD 5.56 for caregiver training). Regarding feasibility, as reflected in attendance, MIM DASH participants had a mean attendance of 6.3 (SD 2.3) sessions, and the caregiver training group had 4.9 (SD 2.9) sessions. Conclusions: This study’s findings demonstrate the feasibility of conducting an internet-based intervention (MIM DASH) for African American women with hypertension who also care for families living with ADRD. These results will inform the design of a larger randomized controlled trial to evaluate the intervention’s efficacy and scalability further. Trial Registration: ClinicalTrials.gov NCT05721482; https://clinicaltrials.gov/study/NCT05721482 International Registered Report Identifier (IRRID): DERR1-10.2196/66975 %M 40146982 %R 10.2196/66975 %U https://www.researchprotocols.org/2025/1/e66975 %U https://doi.org/10.2196/66975 %U http://www.ncbi.nlm.nih.gov/pubmed/40146982 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66393 %T Exploring the Discontinuous Usage Behavior of Digital Cognitive Training Among Older Adults With Mild Cognitive Impairment and Their Family Members: Qualitative Study Using the Extended Model of IT Continuance %A Zhang,Shangyang %A Wu,Min %A Sun,Ruini %A Cui,Changjie %A Zhang,Ziqing %A Liao,Jing %A Gong,Ni %+ School of Nursing, Jinan University, No. 601, Huangpu Avenue West, Tianhe District, Guangzhou, 510632, China, 1 15013217344, gongni_1025@163.com %K digital cognitive training %K discontinuous usage behavior %K acceptance %K mild cognitive impairment %K qualitative study %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital cognitive training (DCT) has been found to be more effective than traditional paper-and-pencil training in enhancing overall cognitive function. However, a significant barrier to its long-term implementation is that older adults with mild cognitive impairment (MCI) do not continue to use it or even show a dropoff in usage after the initial engagement. Such short-term engagement may limit the potential benefits of DCT, as sustained use is required to achieve more pronounced cognitive improvements. Exploring the reasons for the shift in discontinuous usage behavior is crucial for promoting successful DCT implementation and maximizing its positive effects. Objective: This study aimed to explore the intrinsic reasons for the transition from initial acceptance to discontinuous usage behavior among older adults with MCI throughout the DCT process, by employing the extended model of IT continuance (ECM-ITC). Methods: We employed a qualitative research methodology and conducted 38 semistructured interviews before and after the use of DCT (3 times per week over 1 month, with each session lasting 30 minutes) with 19 older adults with MCI (aged 60 years or older) and 4 family members between January and March 2024. Thematic analysis and deductive framework analysis were used to identify the reasons for the discontinuous usage of DCT, with mapping to the ECM-ITC. Results: Most participants failed to complete the standard dosage of DCT. Data analysis revealed the reasons for the shift to discontinuous usage. Despite their need to improve cognitive function, participants found the cognitive training confusing and discovered that DCT did not align with their preferred method of training upon actual use. The disparity between their vague expectations and reality, combined with the contradiction between the “delayed gratification” of DCT and their desire for “immediate gratification,” made it difficult for them to discern the usefulness of DCT. Participants also viewed DCT as an additional financial burden and tended to avoid training under family pressure. They relied on motivational measures, which further weakened their intention to continue DCT, ultimately leading to the inability to develop continuous usage behavior. Conclusions: Continuous usage behavior differs from initial acceptance as it evolves dynamically with user experience over time. To encourage older adults with MCI to persistently engage with DCT, it is essential to not only thoroughly consider their genuine preferences and the potential disruptions DCT may bring to their lives but also bridge the gap between expectations and actual experiences. While ensuring that older adults receive appropriate external incentives and encouragement, it is equally important to foster their intrinsic motivation, thereby gradually cultivating the habit of sustained DCT usage. %M 40132189 %R 10.2196/66393 %U https://www.jmir.org/2025/1/e66393 %U https://doi.org/10.2196/66393 %U http://www.ncbi.nlm.nih.gov/pubmed/40132189 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60296 %T Assessment of Health System Readiness and Quality of Dementia Services in Peru: Protocol for a Qualitative Study With Stakeholder Interviews and Documentation Review %A Lazo-Porras,Maria %A Tateishi-Serruto,Francisco Jose %A Butler,Christopher %A Cuba-Fuentes,María Sofía %A Rossini-Vilchez,Daniela %A Perez-Leon,Silvana %A Lúcar-Flores,Miriam %A Miranda,J Jaime %A Bernabe-Ortiz,Antonio %A Diez-Canseco,Francisco %A Moore,Graham %A Landeiro,Filipa %A Cardenas,Maria Kathia %A Vera Tudela,Juan Carlos %A White,Lee %A Calvo,Rafael A %A Whiteley,William %A Hawkins,Jemma %A , %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av Almendariz 445 Miraflores, Lima, 15074, Peru, 51 998938234, maria.lazo@upch.pe %K dementia %K health system readiness %K caregiver %K comorbidities %K Peru %K study protocol %K quality of care %K comorbidity %K patient journey %K mHealth %D 2025 %7 21.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia and their carers, and the quality of care provided, is scarce in low- and middle-income countries. Objective: This study aims to assess the quality of the health system to provide diagnosis and care for people with dementia and their carers in Peru. In order to do this, the study will explore the response of the Peruvian health system to people with dementia and their carers, and explore the experiences of people with dementia of receiving their diagnosis, management, and quality of care for this condition. Methods: This study is part of a research program called “IMPACT Salud: Innovations using Mhealth for people with dementia and Co-morbidities,” aimed at strengthening health systems to provide care for people with dementia and their carers. The study has a descriptive, cross-sectional design that uses a qualitative methodology, including stakeholder interviews and documentation review, and consists of 2 substudies, a health system assessment (HSA) and an exploration of the patient journey. The first substudy uses an HSA methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across 3 levels of the health system (micro, meso, and macro) in 4 Peruvian regions, each with distinct geographical and urbanization profiles. The second substudy uses a patient journey methodology, which involves conducting 40 in-depth interviews with people with dementia, carers, and health care workers from the same 4 regions. The insights into the people with dementia patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the high-quality health system framework, and the findings from the HSA and patient journey will be structured using the domains included in the framework through the lens of quality of services. Results: Data collection began in March 2024. As of the end of September 2024, a total of 156 interviews from the HSA and 38 interviews from the patient journey study have been conducted across 4 regions. Conclusions: This study will provide a national, multilevel insight into the current operation of the Peruvian health system, including an analysis of the quality of services provided with regard to dementia diagnosis, management, and care from the perspectives of stakeholders, patients, and their carers. International Registered Report Identifier (IRRID): DERR1-10.2196/60296 %M 40117577 %R 10.2196/60296 %U https://www.researchprotocols.org/2025/1/e60296 %U https://doi.org/10.2196/60296 %U http://www.ncbi.nlm.nih.gov/pubmed/40117577 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64074 %T Values of Stakeholders Involved in Applying Surveillance Technology for People With Dementia in Nursing Homes: Scoping Review %A van Gaans-Riteco,Daniëlle %A Stoop,Annerieke %A Wouters,Eveline %+ Academic Collaborative Center Care for Older Adults, Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, Tilburg, 5037DB, The Netherlands, 31 134662969, d.p.c.vangaans-riteco@tilburguniversity.edu %K surveillance technology %K nursing home %K stakeholders %K values %K dementia %K safety %D 2025 %7 20.3.2025 %9 Review %J JMIR Aging %G English %X Background: Due to the progressive nature of dementia, concerns about the safety of nursing home residents are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives. Objective: This study aims to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes. Methods: We conducted a scoping review and systematically searched 5 scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to the theory of basic human values by Schwartz. Results: In total, 12 stakeholder groups were identified, with nursing staff, residents, and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity, and tradition were most commonly addressed. Furthermore, values such as self-direction, power, and achievement seemed important to most stakeholder groups. Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. In addition, they acknowledged the necessity of paying attention to stakeholders’ perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented, although various stakeholders assigned different meanings to these values. Awareness of stakeholders’ perspectives demands a willingness to acknowledge each other’s values and bridge differences. %M 39899267 %R 10.2196/64074 %U https://aging.jmir.org/2025/1/e64074 %U https://doi.org/10.2196/64074 %U http://www.ncbi.nlm.nih.gov/pubmed/39899267 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63686 %T Using Deep Learning to Perform Automatic Quantitative Measurement of Masseter and Tongue Muscles in Persons With Dementia: Cross-Sectional Study %A Imani,Mahdi %A Borda,Miguel G %A Vogrin,Sara %A Meijering,Erik %A Aarsland,Dag %A Duque,Gustavo %K artificial intelligence %K machine learning %K sarcopenia %K dementia %K masseter muscle %K tongue muscle %K deep learning %K head %K tongue %K face %K magnetic resonance imaging %K MRI %K image %K imaging %K muscle %K muscles %K neural network %K aging %K gerontology %K older adults %K geriatrics %K older adult health %D 2025 %7 19.3.2025 %9 %J JMIR Aging %G English %X Background: Sarcopenia (loss of muscle mass and strength) increases adverse outcomes risk and contributes to cognitive decline in older adults. Accurate methods to quantify muscle mass and predict adverse outcomes, particularly in older persons with dementia, are still lacking. Objective: This study’s main objective was to assess the feasibility of using deep learning techniques for segmentation and quantification of musculoskeletal tissues in magnetic resonance imaging (MRI) scans of the head in patients with neurocognitive disorders. This study aimed to pave the way for using automated techniques for opportunistic detection of sarcopenia in patients with neurocognitive disorder. Methods: In a cross-sectional analysis of 53 participants, we used 7 U-Net-like deep learning models to segment 5 different tissues in head MRI images and used the Dice similarity coefficient and average symmetric surface distance as main assessment techniques to compare results. We also analyzed the relationship between BMI and muscle and fat volumes. Results: Our framework accurately quantified masseter and subcutaneous fat on the left and right sides of the head and tongue muscle (mean Dice similarity coefficient 92.4%). A significant correlation exists between the area and volume of tongue muscle, left masseter muscle, and BMI. Conclusions: Our study demonstrates the successful application of a deep learning model to quantify muscle volumes in head MRI in patients with neurocognitive disorders. This is a promising first step toward clinically applicable artificial intelligence and deep learning methods for estimating masseter and tongue muscle and predicting adverse outcomes in this population. %R 10.2196/63686 %U https://aging.jmir.org/2025/1/e63686 %U https://doi.org/10.2196/63686 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67632 %T Network Analysis of Key Instrumental Activities of Daily Living and Cognitive Domains for Targeted Intervention in US Older Adults Without Dementia: Cross-Sectional Study %A Li,Jiaying %A He,Rendong %A Hsu,Erh-Chi %A Li,Junxin %K cognition function %K older adults %K intervention targets %K elder %K elderly %K cognitive impairment %K stimulating activity %K instrumental activities of daily living %K IADL %K daily living activity %K cognitive domain %K non-demented %K cognitive network %K holistic cognition %K holistic cognition function %K network comparison %K central variables %K bridge variables %K network analysis %D 2025 %7 19.3.2025 %9 %J JMIR Aging %G English %X Background: Cognitive impairment in older adults reduces independence and raises health care costs but can be mitigated through stimulating activities. Based on network theory, intricate relationships within and between clusters of instrumental activities of daily living (IADLs) and cognitive domains suggest the existence of central IADLs and cognitive domains, as well as bridge IADLs. Modifying these can significantly enhance daily living activities and cognitive functions holistically. Objective: This study aims to identify central IADLs (key activities within the IADL network), central cognitive domains (key domains within the cognitive network), and bridge IADLs (linking IADL and cognitive networks). These insights will inform targeted interventions to effectively improve IADL and cognitive well-being in older adults. Methods: A cross-sectional analysis of adults aged 65 years and older in the United States focused on 5 IADLs and 6 cognitive domains from the National Health and Aging Trends Study (NHATS). Network analysis identified central and bridge variables. Nonparametric and case-dropping bootstrap methods checked network stability. Network comparison tests assessed sex differences with Benjamini-Hochberg adjustments. Results: Of the 2239 participants, 56.4% were female (n=976). We computed and tested 3 networks: IADL, cognition, and bridge-with correlation stability coefficients of 0.67, 0.75, and 0.44, respectively (all>0.25). Meal preparation was identified as the central IADL, with a centrality index of 3.87, which was significantly higher than that of other IADLs (all P<.05). Visual attention emerged as the central cognition domain, with a centrality index of 0.86, which was significantly higher than that of other cognition domains (all P<.05). Shopping was determined to be the bridge IADL, with a centrality index of 0.41, which was significantly higher than that of other IADLs (all P<.05). Notably, gender differences emerged in the IADL network, with stronger associations between laundry and meal preparation in females (1.69 vs males: 0.74; P=.001) and higher centrality in meal preparation among females (difference=1.99; P=.007). Conclusions: While broad enhancements in all IADL and cognitive domains are beneficial, targeting meal preparation, visual attention, and shopping may leverage their within-network influence to yield a more pronounced improvement in holistic IADL, holistic cognition, and holistic cognition function through IADL interventions among older adults. Notably, meal preparation interventions may be less effective in males, requiring tailored approaches. %R 10.2196/67632 %U https://aging.jmir.org/2025/1/e67632 %U https://doi.org/10.2196/67632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66695 %T Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study %A Doerr,Adam J %A Orwig,Taylor A %A McNulty,Matthew %A Sison,Stephanie Denise M %A Paquette,David R %A Leung,Robert %A Ding,Huitong %A Erban,Stephen B %A Weinstein,Bruce R %A Guilarte-Walker,Yurima %A Zai,Adrian H %A Walkey,Allan J %A Soni,Apurv %A McManus,David D %A Lin,Honghuang %+ Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, S6-755, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K cognitive assessment %K primary care %K digital %K cognitive impairment %K digital assessment %K assessment %K cognitive health %K cognition %K primary care %K cognitive evaluation %K Core Cognitive Evaluation %K CCE %K cohort %K impairment %K cognitive %K outpatient %D 2025 %7 12.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health’s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied. Objective: This study aimed to explore the integration of CCE implementation in a primary care setting. Methods: A cohort of participants was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included individuals aged ≥65 years; ability to read, write, and speak in English or Spanish; no previous diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators collected consent from participants and facilitated the screening process. PCPs reviewed reports in real time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant’s REDCap (Research Electronic Data Capture; Vanderbilt University) record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. Results: The screened cohort included 150 patients with a mean age of 74 (SD 7) years, of whom 65% (97/150) were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. A total of 84 orders were placed for select laboratory tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Before the assessment, 95% (143/150) of patients and all 15 caregivers expressed a desire to know if their or their loved one’s brain health was declining. All except one patient also completed the postassessment survey. Among them, 96% (143/149) of patients reported finding the CCE easy to complete, and 70% (105/149) felt that the experience was beneficial. In addition, 87% (130/149) of patients agreed or strongly agreed that they wanted to know their CCE results. Among the 7 participating PCPs, 6 stated that the CCE results influenced their patient care management, and all 7 indicated they would continue using the CCE if it were made available after the study. Conclusions: We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world. %M 40073397 %R 10.2196/66695 %U https://formative.jmir.org/2025/1/e66695 %U https://doi.org/10.2196/66695 %U http://www.ncbi.nlm.nih.gov/pubmed/40073397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59892 %T Intelligent Robot Interventions for People With Dementia: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Fan,Wenqi %A Zhao,Rui %A Liu,Xiaoxia %A Ge,Lina %+ Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Heping District/Sanhao Street, 36th, Shenyang, 110004, China, 86 18940251669, geln@sj-hospital.org %K intelligent robot %K artificial intelligence %K dementia %K agitation %K anxiety %K meta-analysis %D 2025 %7 10.3.2025 %9 Review %J J Med Internet Res %G English %X Background: The application of intelligent robots in therapy is becoming more and more important for people with dementia. More extensive research is still needed to evaluate its impact on behavioral and psychological dementia symptoms, as well as quality of life in different care settings. Objective: The purpose of this research is to methodically assess how well intelligence robot interventions work for patients with dementia. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, a comprehensive search was conducted on PubMed, CINAHL, the Cochrane Library, Embase, and Web of Science from the time of their founding to February 2024, to identify relevant randomized controlled trials on the use of intelligent robots in people with dementia. Two authors (WF and RZ) independently applied the Cochrane Collaboration bias assessment tool to assess the included studies’ quality. The intervention effect of intelligent robots on patients with dementia was summarized using a fixed-effect model or a random-effects model with Stata software (version 16.0; StataCorp). Subgroup analysis was performed according to the intelligent robot type and the intervention duration. Publication bias was tested using funnel plots, Egger tests, and the trim-and-fill method. Results: In total, 15 studies were finally included for systematic review, encompassing 705 participants, of which 12 studies were subjected to meta-analysis. The meta-analysis found that compared with the control group, intelligent robot intervention significantly reduced the levels of agitation (standardized mean difference –0.36, 95% CI –0.56 to –0.17; P<.001) and anxiety (weighted mean difference –1.93, 95% CI –3.13 to –0.72; P=.002) in patients with dementia. However, the intervention of intelligent robots had no significant effect on the following (all P>.05): cognitive function, neuropsychiatric symptoms, depression, quality of life, step count during the day, and the hours of lying down during the night of patients with dementia. Subgroup analysis revealed that the improvement of depression was related to the duration of the intervention (≤12 vs 12 weeks: 0.08, 95% CI –0.20 to 0.37 vs –0.68, 95% CI –1.00 to –0.37; P=.26) and was independent of the type of intelligent robots (animal robots vs humanoid robots: –0.30, 95% CI –0.75 to 0.15 vs 0.07, 95% CI –0.21 to –0.34; P=.26). Conclusions: This study shows that intelligent robot intervention can help improve the agitation and anxiety levels of people with dementia. The intervention may be more effective the longer it is implemented. The appearance of the intelligent robot has no effect on the intervention effect. Further research is needed to help collect physiological data, such as physical activity in people with dementia; explore the impact of other intelligent robot design features on the intervention effect; and provide a reference for improving intelligent robots and intervention programs. Trial Registration: PROSPERO CRD42024523007; https://tinyurl.com/mwscn985 %M 40063933 %R 10.2196/59892 %U https://www.jmir.org/2025/1/e59892 %U https://doi.org/10.2196/59892 %U http://www.ncbi.nlm.nih.gov/pubmed/40063933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56692 %T Use of Artificial Intelligence, Internet of Things, and Edge Intelligence in Long-Term Care for Older People: Comprehensive Analysis Through Bibliometric, Google Trends, and Content Analysis %A Chien,Shuo-Chen %A Yen,Chia-Ming %A Chang,Yu-Hung %A Chen,Ying-Erh %A Liu,Chia-Chun %A Hsiao,Yu-Ping %A Yang,Ping-Yen %A Lin,Hong-Ming %A Yang,Tsung-En %A Lu,Xing-Hua %A Wu,I-Chien %A Hsu,Chih-Cheng %A Chiou,Hung-Yi %A Chung,Ren-Hua %+ Institute of Population Health Sciences, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County, 350, Taiwan, 886 37 246 166 ext 36105, rchung@nhri.edu.tw %K bibliometric analysis %K Google Trends %K content analysis %K long-term care %K older adults %K artificial intelligence %K Internet of Things %K edge intelligence %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The global aging population poses critical challenges for long-term care (LTC), including workforce shortages, escalating health care costs, and increasing demand for high-quality care. Integrating artificial intelligence (AI), the Internet of Things (IoT), and edge intelligence (EI) offers transformative potential to enhance care quality, improve safety, and streamline operations. However, existing research lacks a comprehensive analysis that synthesizes academic trends, public interest, and deeper insights regarding these technologies. Objective: This study aims to provide a holistic overview of AI, IoT, and EI applications in LTC for older adults through a comprehensive bibliometric analysis, public interest insights from Google Trends, and content analysis of the top-cited research papers. Methods: Bibliometric analysis was conducted using data from Web of Science, PubMed, and Scopus to identify key themes and trends in the field, while Google Trends was used to assess public interest. A content analysis of the top 1% of most-cited papers provided deeper insights into practical applications. Results: A total of 6378 papers published between 2014 and 2023 were analyzed. The bibliometric analysis revealed that the United States, China, and Canada are leading contributors, with strong thematic overlaps in areas such as dementia care, machine learning, and wearable health monitoring technologies. High correlations were found between academic and public interest, in key topics such as “long-term care” (τ=0.89, P<.001) and “caregiver” (τ=0.72, P=.004). The content analysis demonstrated that social robots, particularly PARO, significantly improved mood and reduced agitation in patients with dementia. However, limitations, including small sample sizes, short study durations, and a narrow focus on dementia care, were noted. Conclusions: AI, IoT, and EI collectively form a powerful ecosystem in LTC settings, addressing different aspects of care for older adults. Our study suggests that increased international collaboration and the integration of emerging themes such as “rehabilitation,” “stroke,” and “mHealth” are necessary to meet the evolving care needs of this population. Additionally, incorporating high-interest keywords such as “machine learning,” “smart home,” and “caregiver” can enhance discoverability and relevance for both academic and public audiences. Future research should focus on expanding sample sizes, conducting long-term multicenter trials, and exploring broader health conditions beyond dementia, such as frailty and depression. %M 40053718 %R 10.2196/56692 %U https://www.jmir.org/2025/1/e56692 %U https://doi.org/10.2196/56692 %U http://www.ncbi.nlm.nih.gov/pubmed/40053718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63572 %T Experiences With an In-Bed Real-Time Motion Monitoring System on a Geriatric Ward: Mixed Methods Study %A Walzer,Stefan %A Schön,Isabel %A Pfeil,Johanna %A Merz,Nicola %A Marx,Helga %A Ziegler,Sven %A Kunze,Christophe %+ , Care and Technology Lab, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen im Schwarzwald, 78120, Germany, 49 7723920295, stefan.walzer@hs-furtwangen.de %K nurses %K geriatric patients %K cognitive impairment %K technology %K fall prevention %K hospital %K mixed methods %K patient %K learning process %K assessment %K autonomy %K impairment %K real-time motion %K university %K geriatric ward %K survey %K anxiety %K willingness %K patient privacy %K effectiveness %K monitoring system %K health care practice %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults now make up about two-thirds of hospital admissions, with up to 50% experiencing cognitive impairments such as dementia. These patients often struggle with adherence to care plans and maintaining regular day or night cycles, presenting challenges for nurses. Hospitals are typically unprepared to manage this patient population, resulting in increased nurse workload and challenges like managing motor agitation, which can lead to falls or accidental removal of medical devices. Objective: This study aimed to (1) assess how an in-bed real-time motion monitoring system (IRMS) impacts nurses’ perceptions of physical and mental stress, (2) evaluate the IRMS’s effect on the care process, (3) explore ethical implications like patient autonomy and privacy, and (4) understand how nurses acquire knowledge about the technology and how this affects their assessment of the IRMS. Methods: The IRMS, which provides real-time motion monitoring and bed edge or exit information, was implemented in the geriatric ward of a university medical center. The study followed a monocentric, explorative evaluation design using a mixed methods approach. It lasted 24 weeks and had two phases. In Phase 0 (6 weeks), patients received standard care. In Phase 1 (18 weeks), the IRMS was introduced. Initial data were gathered through focus groups and participant observations during manufacturer training sessions. At the end of the intervention, a survey, a second focus group, and an interview were conducted to capture nurses’ experiences. The study follows the Good Reporting of a Mixed Method Study (GRAMMS) checklist for reporting. Results: Initial training sessions with 12 participants (10 nurses and 2 physiotherapists) showed varying levels of engagement, with the second session demonstrating more optimism and interprofessional collaboration. A total of 10 questionnaires were completed (10/21, 48%). Survey results showed that 80% (8/10) of nurses found the IRMS valuable for assessing the quality of work, and 90% (9/10) were willing to continue using it. The system was regarded as reliable for monitoring bed edge and exit events. Usability was positively rated, with minimal concerns about documentation burden. Focus group discussions (n=3 per session) indicated that nurses viewed the system as reliable and appreciated its role in reducing anxiety related to fall prevention. However, concerns about patient privacy and monitoring were raised. Nurses expressed a willingness to continue using the IRMS but reaffirmed their ability to care for patients without it. Conclusions: Nurses had a generally positive attitude toward the IRMS, recognizing its benefits, particularly for nighttime monitoring. Although its effectiveness in preventing falls remains inconclusive, the system helps reduce nurses’ fear of falls and enhances their responsiveness. The study highlights the broader impact of the IRMS beyond fall prevention and stresses the importance of thoughtful integration into health care practice. %M 40053780 %R 10.2196/63572 %U https://formative.jmir.org/2025/1/e63572 %U https://doi.org/10.2196/63572 %U http://www.ncbi.nlm.nih.gov/pubmed/40053780 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e54797 %T Machine Learning Analysis of Engagement Behaviors in Older Adults With Dementia Playing Mobile Games: Exploratory Study %A Torabgar,Melika %A Figeys,Mathieu %A Esmail,Shaniff %A Stroulia,Eleni %A Ríos Rincón,Adriana M %K dementia %K gaming %K engagement %K cognition %K machine learning %K games %K cognitive %K screening %K classification %K Alzheimer disease %K gerontology %K geriatric %K older adult %K elderly %K aging %D 2025 %7 3.3.2025 %9 %J JMIR Serious Games %G English %X Background: The prevalence of dementia is expected to rise with an aging population, necessitating accessible early detection methods. Serious games have emerged as potential cognitive screening tools. They provide not only an engaging platform for assessing cognitive function but also serve as valuable indicators of cognitive health through engagement levels observed during play. Objective: This study aims to examine the differences in engagement-related behaviors between older adults with and without dementia during serious gaming sessions. Further, it seeks to identify the key contributors that enhance the effectiveness of machine learning for dementia classification based on engagement-related behaviors. Methods: This was an exploratory proof-of-concept study. Over 8 weeks, 20 older adults, 6 of whom were living with dementia, were enrolled in a single-case design study. Participants played 1 of 4 “Vibrant Minds” serious games (Bejeweled, Whack-A-Mole, Mah-jong, and Word-Search) over 8 weeks (16 30-min sessions). Throughout the study, sessions were recorded to analyze engagement-related behaviors. This paper reports on the analysis of the engagement-related behaviors of 15 participants. The videos of these 15 participants (10 cognitively intact, 5 with dementia) were analyzed by 2 independent raters, individually annotating engagement-related behaviors at 15-second intervals using a coding system. This analysis resulted in 1774 data points categorized into 47 behavior codes, augmented by 54 additional features including personal characteristics, technical issues, and environmental factors. Each engagement-related behavior was compared between older adults living with dementia and older adults without dementia using the χ² test with a 2×2 contingency table with a significance level of .05. Codes underwent one-hot encoding and were processed using random forest classifiers to distinguish between participant groups. Results: Significant differences in 64% of engagement-related behaviors were found between groups, notably in torso movements, voice modulation, facial expressions, and concentration. Including engagement-related behaviors, environmental disturbances, technical issues, and personal characteristics resulted in the best model for classifying cases of dementia correctly, achieving an F1-score of 0.91 (95% CI 0.851‐0.963) and an area under the receiver operating curve of 0.99 (95% CI 0.984‐1.000). Conclusions: Key features distinguishing between older adults with and without dementia during serious gameplay included torso, voice, facial, and concentration behaviors, as well as age. The best performing machine learning model identified included features of engagement-related behavios, environmental disturbances, technical challenges, and personal attributes. Engagement-related behaviors observed during serious gaming offer crucial markers for identifying dementia. Machine learning models that incorporate these unique behavioral markers present a promising, noninvasive approach for early dementia screening in a variety of settings. %R 10.2196/54797 %U https://games.jmir.org/2025/1/e54797 %U https://doi.org/10.2196/54797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54847 %T Understanding Challenges and Emotions of Informal Caregivers of General Older Adults and People With Alzheimer Disease and Related Dementia: Comparative Study %A Huang,Nova Mengxia %A Wong,Liang Ze %A Ho,Shirley S %A Timothy,Bryan %+ Nanyang Technological University, Wee Kim Wee School of Communication and Information, 31 Nanyang Link, Singapore, 637718, Singapore, 65 6513 8667, tsyho@ntu.edu.sg %K informal caregivers %K older adults %K Alzheimer disease and related dementia %K online support communities %K Reddit %D 2025 %7 28.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Faced with multiple challenges, informal caregivers often turn to online support communities for information and support. While scholarly attention has focused on experiences expressed by informal caregivers in these communities, how caregivers’ challenges and emotional expressions vary across different health contexts remains understudied. Objective: We aimed to examine and compare the challenges discussed by informal caregivers of general older adults and those of patients with Alzheimer disease and related dementia, as well as their emotional expressions, on Reddit. In addition, we examined how informal caregivers expressed their emotions in response to various challenges. Methods: We collected posts from 6 subreddits, including 3 subreddits on caregiving for older adults and 3 on caregiving for patients with Alzheimer disease and related dementia. Using topic modeling, we identified topics discussed by caregivers in the collected posts. We further used deep reading to contextualize these topics and understand the challenges behind them, conducted sentiment analysis to investigate their emotional expressions, and used Spearman rank-order correlation to examine the relationship between the obtained topics and emotions. Results: In total, 3028 posts were retrieved, including 1552 from older adult–related subreddits and 1476 from Alzheimer disease–related subreddits; 18 key topics were identified, with the most frequent topics being expressing feelings (2178/3028, 71.93%) and seeking advice and support (1982/3028, 65.46%). Other topics covered various challenges in caregiving, such as duration of medical care (1954/3028, 64.53%), sleep and incontinence (1536/3028, 50.73%), financial issues (1348/3028, 44.52%), and nursing home (1221/3028, 40.32%). There was a positive, negligible correlation between expressing feelings and seeking advice and support (ρ=0.09, P<.001). Other topics also showed positive, negligible or weak correlations with these 2 topics but in distinct patterns. Posts from older adult–related subreddits were more focused on practical caregiving issues and seeking advice and support, whereas posts from Alzheimer disease–related subreddits emphasized health- and medical-related topics and expressing feelings. Caregivers in both contexts predominantly expressed negative emotions (older adults: 1263/1552, 81.38%; Alzheimer disease: 1247/1476, 84.49%), with caregivers in Alzheimer disease–related subreddits exhibiting slightly greater fear and sadness (P<.001). Specific challenges were significantly correlated with negative emotions: duration of medicalcare was positively, weakly correlated with anger (ρ=0.25, P<.001), fear (ρ=0.25, P<.001), and sadness (ρ=0.22, P<.001). Medical appointments were positively, negligibly correlated with anger (ρ=0.10, P<.001), fear (ρ=0.09, P<.001), and sadness (ρ=0.06, P<.001). Sleep and incontinence (ρ=0.14, P<.001) and finances (ρ=0.24, P<.001) were positively, weakly correlated with anger. Conclusions: By identifying the challenges and feelings expressed by caregivers for general older adults and caregivers for patients with Alzheimer disease and related dementia, our findings could inform health practitioners and policy makers in developing more targeted support interventions for informal caregivers in different contexts. %M 40053723 %R 10.2196/54847 %U https://www.jmir.org/2025/1/e54847 %U https://doi.org/10.2196/54847 %U http://www.ncbi.nlm.nih.gov/pubmed/40053723 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65292 %T Performance of a Digital Cognitive Assessment in Predicting Dementia Stages Delineated by the Dementia Severity Rating Scale: Retrospective Study %A Huynh,Duong %A Sun,Kevin %A Patterson,Mary %A Hosseini Ghomi,Reza %A Huang,Bin %K stage %K severity %K progression %K correlation %K association %K cognitive impairment %K functional activities %K cognitive assessment %K BrainCheck %K dementia %K Alzheimer disease %K gerontology %K geriatric %K old %K elderly %K aging %K retrospective analysis %K digital assessment %K patient assessment %K digital cognitive assessment %K digital health %K neurodegeneration %K memory loss %K memory function %K risk factors %D 2025 %7 26.2.2025 %9 %J JMIR Aging %G English %X Background: Dementia is characterized by impairments in an individual’s cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied. Objective: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy. Methods: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10‐18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients’ BC-OS and ADL-TS to predict their stage. Results: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=−0.53), between DSRS-TS and ADL-TS (r=−0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961. Conclusions: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints. %R 10.2196/65292 %U https://aging.jmir.org/2025/1/e65292 %U https://doi.org/10.2196/65292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57264 %T Weighted Blankets for Agitation in Hospitalized Patients with Dementia: Protocol for a Randomized Controlled Trial %A Schenzel,Holly A %A Palmer,Allyson K %A Shah,Neel B %A Lawson,Donna K %A Fischer,Karen M %A Lapid,Maria I %A DeFoster,Ruth E %+ Division of Hospital Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 5072554656, schenzel.holly@mayo.edu %K dementia %K hospitalized dementia patients %K agitation %K aggression %K behaviors %K sleep %K weighted blankets %K nonpharmacologic strategy %K pilot study %K inpatients %K occupational therapy %D 2025 %7 26.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are limited therapies approved for the treatment of aggression and agitation in patients with dementia. While antipsychotics and benzodiazepines are commonly used, these medications have been associated with significant side effects and US Food and Drug Administration (FDA) boxed warnings. Weighted blankets have been associated with decreased anxiety and improved sleep. Weighted blankets are potentially a nonpharmacologic option to reduce agitation in hospitalized patients with dementia. Objective: The aim of this study is to investigate the effect of weighted blankets on aggression and agitation in hospitalized patients with dementia. Methods: A pilot study will be conducted on a total of 30 hospitalized patients with a documented clinical diagnosis of dementia and ongoing agitated behaviors admitted to a medicine or psychiatry service. Patients will be randomly allocated to receive either a weighted blanket for 3 nights or continued usual care. The primary outcome is the change in the observational version of the Cohen-Mansfield Agitation Inventory (CMAI-O) over the course of the 3-night study period. The secondary outcomes are changes in Edmonton Symptom Assessment System Revised (ESAS-r) and Clinical Global Impression (CGI) scores, hours of sleep, use of antipsychotics and benzodiazepines, and incidence of delirium. Identical study assessments will be completed for both the usual care and the weighted blanket study groups. At 5 study time points (baseline, postnight 1, postnight 2, postnight 3, and a final assessment 48-72 h after the last use of the weighted blanket), patients will be assessed with the CMAI-O, ESAS-r, and CGI tools. All assessments will be completed by the bedside nurse or patient care assistant caring for the patient each day. Within 2 to 4 weeks post discharge from the hospital, study coordinators will contact the patient’s legally authorized representative (LAR) to assess for continued use of the weighted blanket. Results: Enrollment of participants began on April 23, 2023. As of November 2024, a total of 24 participants have been enrolled in the study. Baseline characteristics of enrolled participants will be analyzed and reported upon completion of enrollment. We anticipate completing data collection by March 2026. Conclusions: The study will determine the effect of weighted blankets on agitation in hospitalized patients with dementia. Insights into the effect of weighted blankets on sleep will also be gained. The results of this study will be relevant in the setting of increasing numbers of older adults with dementia exhibiting agitation, leading to increased hospitalizations, caregiver burden, and health care costs. Trial Registration: ClinicalTrials.gov NCT03643991; http://clinicaltrials.gov/ct2/show/NCT03643991 International Registered Report Identifier (IRRID): DERR1-10.2196/57264 %M 40009836 %R 10.2196/57264 %U https://www.researchprotocols.org/2025/1/e57264 %U https://doi.org/10.2196/57264 %U http://www.ncbi.nlm.nih.gov/pubmed/40009836 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64148 %T Estimation of Machine Learning–Based Models to Predict Dementia Risk in Patients With Atherosclerotic Cardiovascular Diseases: UK Biobank Study %A Gu,Zhengsheng %A Liu,Shuang %A Ma,Huijuan %A Long,Yifan %A Jiao,Xuehao %A Gao,Xin %A Du,Bingying %A Bi,Xiaoying %A Shi,Xingjie %+ KLATASDS-MOE, Academy of Statistics and Interdisciplinary Sciences, School of Statistics, East China Normal University, No 3663 North Zhongshan Road, Putuo District, Shanghai, 200062, China, 86 21 622 332 23, xjshi@fem.ecnu.edu.cn %K atherosclerotic cardiovascular disease %K dementia %K Alzheimer disease %K vascular dementia %K machine learning %K UK Biobank %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The atherosclerotic cardiovascular disease (ASCVD) is associated with dementia. However, the risk factors of dementia in patients with ASCVD remain unclear, necessitating the development of accurate prediction models. Objective: The aim of the study is to develop a machine learning model for use in patients with ASCVD to predict dementia risk using available clinical and sociodemographic data. Methods: This prognostic study included patients with ASCVD between 2006 and 2010, with registration of follow-up data ending on April 2023 based on the UK Biobank. We implemented a data-driven strategy, identifying predictors from 316 variables and developing a machine learning model to predict the risk of incident dementia, Alzheimer disease, and vascular dementia within 5, 10, and longer-term follow-up in patients with ASCVD. Results: A total of 29,561 patients with ASCVD were included, and 1334 (4.51%) developed dementia during a median follow-up time of 10.3 (IQR 7.6-12.4) years. The best prediction model (UK Biobank ASCVD risk prediction model) was light gradient boosting machine, comprising 10 predictors including age, time to complete pairs matching tasks, mean time to correctly identify matches, mean sphered cell volume, glucose levels, forced expiratory volume in 1 second z score, C-reactive protein, forced vital capacity, time engaging in activities, and age first had sexual intercourse. This model achieved the following performance metrics for all incident dementia: area under the receiver operating characteristic curve: mean 0.866 (SD 0.027), accuracy: mean 0.883 (SD 0.010), sensitivity: mean 0.637 (SD 0.084), specificity: mean 0.914 (SD 0.012), precision: mean 0.479 (SD 0.031), and F1-score: mean 0.546 (SD 0.043). Meanwhile, this model was well-calibrated (Kolmogorov-Smirnov test showed goodness-of-fit P value>.99) and maintained robust performance across different temporal cohorts. Besides, the model had a beneficial potential in clinical practice with a decision curve analysis. Conclusions: The findings of this study suggest that predictive modeling could inform patients and clinicians about ASCVD at risk for dementia. %M 40009844 %R 10.2196/64148 %U https://aging.jmir.org/2025/1/e64148 %U https://doi.org/10.2196/64148 %U http://www.ncbi.nlm.nih.gov/pubmed/40009844 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65221 %T Real-World Insights Into Dementia Diagnosis Trajectory and Clinical Practice Patterns Unveiled by Natural Language Processing: Development and Usability Study %A Paek,Hunki %A Fortinsky,Richard H %A Lee,Kyeryoung %A Huang,Liang-Chin %A Maghaydah,Yazeed S %A Kuchel,George A %A Wang,Xiaoyan %K dementia %K memory loss %K memory %K cognitive %K Alzheimer disease %K natural language processing %K NLP %K deep learning %K machine learning %K real-world insights %K electronic health records %K EHR %K cohort %K diagnosis %K diagnostic %K trajectory %K pattern %K prognosis %K geriatric %K older adults %K aging %D 2025 %7 25.2.2025 %9 %J JMIR Aging %G English %X Background: Understanding the dementia disease trajectory and clinical practice patterns in outpatient settings is vital for effective management. Knowledge about the path from initial memory loss complaints to dementia diagnosis remains limited. Objective: This study aims to (1) determine the time intervals between initial memory loss complaints and dementia diagnosis in outpatient care, (2) assess the proportion of patients receiving cognition-enhancing medication prior to dementia diagnosis, and (3) identify patient and provider characteristics that influence the time between memory complaints and diagnosis and the prescription of cognition-enhancing medication. Methods: This retrospective cohort study used a large outpatient electronic health record (EHR) database from the University of Connecticut Health Center, covering 2010‐2018, with a cohort of 581 outpatients. We used a customized deep learning–based natural language processing (NLP) pipeline to extract clinical information from EHR data, focusing on cognition-related symptoms, primary caregiver relation, and medication usage. We applied descriptive statistics, linear, and logistic regression for analysis. Results: The NLP pipeline showed precision, recall, and F1-scores of 0.97, 0.93, and 0.95, respectively. The median time from the first memory loss complaint to dementia diagnosis was 342 (IQR 200-675) days. Factors such as the location of initial complaints and diagnosis and primary caregiver relationships significantly affected this interval. Around 25.1% (146/581) of patients were prescribed cognition-enhancing medication before diagnosis, with the number of complaints influencing medication usage. Conclusions: Our NLP-guided analysis provided insights into the clinical pathways from memory complaints to dementia diagnosis and medication practices, which can enhance patient care and decision-making in outpatient settings. %R 10.2196/65221 %U https://aging.jmir.org/2025/1/e65221 %U https://doi.org/10.2196/65221 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e56584 %T Acceptance Factors and Barriers to the Implementation of a Digital Intervention With Older Adults With Dementia or Caregivers: Protocol for an Umbrella Review %A Madeira,Ricardo %A Esteves,Dulce %A Pinto,Nuno %A Vercelli,Alessandro %A Vaz Patto,Maria %+ Department of Sport Sciences, University of Beira Interior, R. do Bairro da Nossa Sra. Da Conceição 22, Covilhã, 6201-001, Portugal, 351 275629153, ricardomadeira94@gmail.com %K dementia %K aging %K telemedicine %K implementation %K digital intervention %K older people %K elderly %K geriatrics %K mobile applications %K barriers %K adherence %K caregivers %K self-management %K acceptability %D 2025 %7 24.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory. Objective: The aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers. Methods: A review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts. Results: The analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024. Conclusions: This review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations. %M 39993296 %R 10.2196/56584 %U https://www.researchprotocols.org/2025/1/e56584 %U https://doi.org/10.2196/56584 %U http://www.ncbi.nlm.nih.gov/pubmed/39993296 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64465 %T Tablet- and Group-Based Multicomponent Cognitive Stimulation for Older Adults With Mild Cognitive Impairment: Single-Group Pilot Study and Protocol for Randomized Controlled Trial %A Jornkokgoud,Khanitin %A Makmee,Pattrawadee %A Wongupparaj,Peera %A Grecucci,Alessandro %+ Department of Psychology, Faculty of Humanities and Social Sciences, Burapha University, 169 Long-Haad Bang Saen Road, Saen-Sook Sub-district, Mueang District, Chon Buri, 20131, Thailand, 66 38 102622, peera.wo@go.buu.ac.th %K computerized cognitive stimulation %K multisensory integration %K cognitive decline %K aging %K electroencephalography %K randomized controlled trial %K RCT %K protocol %K cognitive stimulation %K mild cognitive impairment %K cognitive %K cognition %K cognitive simulation therapy %K CST %K MCI %K tablet %K effectiveness %K pilot study %K neuropsychological tests %K behavioral %K emotional %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive stimulation therapy is a group-based psychological treatment for people with dementia as well as those with mild cognitive impairment (MCI) and is shown to improve both cognition and quality of life. Previous studies have indicated the potential to benefit from the use of technological devices in group interventions. Objective: The pilot study aimed to assess the effectiveness of a tablet- and group-based multicomponent cognitive stimulation therapy (MCST) for enhancing cognitive functions among older adults with MCI. The following study aims to report the protocol for a trial evaluating whether the MCST program is affecting individuals with MCI. Methods: In the first study, 30 individuals with MCI participated in 10 sessions of the tablet- and group-based MCST group. A subsequent protocol study will compare tablet-based MCST, tablet-based cognitive stimulation therapy, and control groups among 93 individuals with MCI. All participants will be recruited from older adults living in semiurban communities. Intervention groups will be facilitated by trained therapists, nurses, or psychologists. The study will be assessed by a pre- and posttest evaluation, including computer-based neuropsychological tests and electroencephalography assessment. The effects of several indicators, such as cognitive functions, behavioral, and emotional, will be analyzed as being indexed by their neurophysiological data. Results: The pilot study showed significant cognitive improvement (P<.001), reduced depression (P=.002), and decreased state anxiety (P=.001) post intervention. Quality of life remained unchanged (P=.18). The randomized controlled trial study was funded in March 2023. Enrolling began in August 2023 and was completed in December 2023. The data analysis was started, and the results are expected to be published by mid- to late-2025. Conclusions: The study is the first tablet-group–based MCST for older adults with MCI in middle-income countries. It will provide deeper insight into participants’ neuropsychological data, thus identifying specific processes underlying physiologically measured positive outcomes. Furthermore, the project will deliver solid and integrative results to mental health professionals in terms of knowledge and guidance for implementing the tablet- and group-based MCST in people with MCI. Trial Registration: Thai Clinical Trials Registry TCTR20230829004; https://tinyurl.com/3wuaue3e International Registered Report Identifier (IRRID): DERR1-10.2196/64465 %M 39983114 %R 10.2196/64465 %U https://www.researchprotocols.org/2025/1/e64465 %U https://doi.org/10.2196/64465 %U http://www.ncbi.nlm.nih.gov/pubmed/39983114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53087 %T Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study %A Krewulak,Karla %A Strayer,Kathryn %A Jaworska,Natalia %A Spence,Krista %A Foster,Nadine %A Kupsch,Scotty %A Sauro,Khara %A Fiest,Kirsten M %+ , Department of Critical Care Medicine, University of Calgary, MT 04111, 3260 Hospital Drive NW, Calgary, AB, , Canada, 1 9448768, kmfiest@ucalgary.ca %K education %K health information %K internet %K delirium %K patient %K caregiver %K brain lesions %K confusion %K inattentiveness %K disorientation %K family education %K information seeking %K readability %K high-quality websites %K accessibility %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords “delirium” and the misspelled “delerium” to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20%) from commercial websites (20/106, 19%), government-affiliated organizations (19/106, 18%), or from a foundation or advocacy group (16/106, 15%). The median time since the last content update was 3 (IQR 2-5) years. Most websites’ content (101/106, 95%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites’ content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. %M 39977019 %R 10.2196/53087 %U https://www.jmir.org/2025/1/e53087 %U https://doi.org/10.2196/53087 %U http://www.ncbi.nlm.nih.gov/pubmed/39977019 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64716 %T Digital Migration of the Loewenstein Acevedo Scales for Semantic Interference and Learning (LASSI-L): Development and Validation Study in Older Participants %A Harvey,Philip %A Curiel-Cid,Rosie %A Kallestrup,Peter %A Mueller,Annalee %A Rivera-Molina,Andrea %A Czaja,Sara %A Crocco,Elizabeth %A Loewenstein,David %K mild cognitive impairment %K cognitive challenge tests %K elder %K aging %K amyloid biomarkers %K cognition %K cognitive decline %K deterioration %K semantic interference %K Alzheimer disease %K self-administered %K voice recognition %K technology %K assessment study %K accuracy %K artificial intelligence %K treatment %K medication %K mental health %K biomarkers %K amnesia %K neurodegeneration %K patient health %K health monitoring %K digital mental health %K neuroscience %K neurotechnology %K Loewenstein Acevedo Scales for Semantic Interference and Learning %K LASSI-L %K digital Loewenstein-Acevedo Scales for Semantic Interference %K LASSI-D %D 2025 %7 19.2.2025 %9 %J JMIR Ment Health %G English %X Background: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention. Objective: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence–generated avatar assistant, was the migrated assessment. Methods: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions. Results: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants. Conclusions: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test. %R 10.2196/64716 %U https://mental.jmir.org/2025/1/e64716 %U https://doi.org/10.2196/64716 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66838 %T Neural Mechanism of Cognitive Reserve in Acupuncture Stimulation: Protocol for a Randomized, Placebo-Controlled Functional Near-Infrared Spectroscopy Trial %A Shin,Hyeonsang %A Seong,Woohyun %A Woo,Yeonju %A Kim,Joo-Hee %A Park,Kwang-Rak %A Lee,Dong Hyuk %+ Department of Anatomy, College of Korean Medicine, Sangji University, 83 Sangjidae-gil, Wonju-si, Gangwon-do, 26339, Republic of Korea, 82 01071017317, leedh1103@gmail.com %K cognitive reserve %K acupuncture %K dementia %K mild cognitive impairment %K neuroimaging %K fNIRS %K brain connectivity %K neural mechanism %K RCT %K randomized controlled trial %D 2025 %7 19.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a clinical syndrome characterized by a progressive decline in various cognitive domains. Since there is still no treatment for dementia, early diagnosis and prevention are the best approaches. In this context, the cognitive reserve (CR) concept has received considerable attention in dementia research with regard to prognosis. It originates from discrepancies between the degree of brain pathology and clinical manifestations. Acupuncture, as a complementary intervention, has long been widely applied in neurological diseases in East Asia. At the macroscale level, how acupuncture stimulation affects neural activity concerning CR in normal aging and dementia is largely unknown. Objective: The aim of this study is to investigate the acute neural mechanisms of acupuncture stimulation concerning CR in the normal aging group and the group with cognitive impairment using neuroimaging methods. Methods: This study is a randomized, placebo-controlled trial. Participants without (n=30) and with cognitive impairment (n=30) will be randomly assigned to the verum or sham acupuncture groups. The verum acupuncture group will receive acupuncture stimulation at acupoints related to cognitive function and gain deqi sensation. The sham acupuncture group will receive superficial needling at nonacupoints not related to cognitive function. Each group will undergo cognitive function tests, functional near-infrared spectroscopy imaging before and after acupuncture stimulation, and an assessment of CR. The primary outcomes will be differences in resting brain activities according to disease status, differences in resting brain connectivity before and after acupuncture stimulation between the 2 groups, and changes in brain activity in relation to the CR index. The secondary outcomes will be brain connectivity or network metrics associated with CR and differences in neural activity between the cognitive task and resting states. Results: The recruitment began in August 2023; to date, there have been 50 participants, divided into 20 in the group with cognitive impairment and 30 in the unimpaired group. The recruitment process will continue until February 2025. Conclusions: CR refers to the individual susceptibility to age-related brain changes and pathologies in cognitive impairment, and it is a factor affecting the trajectories of the disease. Although acupuncture is a widely used intervention for various neurological diseases, including dementia, its mechanism associated with CR at the macroscale has not been clearly identified. This study could contribute to identifying the neural mechanisms of acupuncture stimulation associated with CR using neuroimaging methods and provide a basis for future longitudinal research. Trial Registration: Clinical Research Information Service of the Republic of Korea KCT0008719; https://tinyurl.com/ydv5537n International Registered Report Identifier (IRRID): DERR1-10.2196/66838 %M 39970435 %R 10.2196/66838 %U https://www.researchprotocols.org/2025/1/e66838 %U https://doi.org/10.2196/66838 %U http://www.ncbi.nlm.nih.gov/pubmed/39970435 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65379 %T Digital Isolation and Dementia Risk in Older Adults: Longitudinal Cohort Study %A Deng,Cheng %A Shen,Na %A Li,Guangzhou %A Zhang,Ke %A Yang,Shijun %+ Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China, 86 13971132795, yangsj1218@163.com %K dementia %K digital isolation %K cognitive decline %K older adults %K elderly %K geriatric %K longitudinal cohort study %K cognitive impairment %K aging %K social isolation %K risk %K digital engagement %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation, a phenomenon unique to the digital age, remains underexplored. Objective: This study aimed to investigate the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia. Methods: We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8189 participants aged 65 years and older from the 3rd (2013) to the 12th wave (2022). Digital isolation was quantified using a composite digital isolation index, derived from participants’ usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were used to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables. Results: The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared with the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.22 (95% CI 1.01-1.47, P=.04), while the validation cohort showed an HR of 1.62 (95% CI 1.27-2.08, P<.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.36 (95% CI 1.16-1.59, P<.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group. Conclusions: Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention. %M 39969956 %R 10.2196/65379 %U https://www.jmir.org/2025/1/e65379 %U https://doi.org/10.2196/65379 %U http://www.ncbi.nlm.nih.gov/pubmed/39969956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69109 %T Evaluating the Clinical Efficacy of an Exergame-Based Training Program for Enhancing Physical and Cognitive Functions in Older Adults With Mild Cognitive Impairment and Dementia Residing in Rural Long-Term Care Facilities: Randomized Controlled Trial %A Li,Aoyu %A Qiang,Wei %A Li,Jingwen %A Geng,Yan %A Qiang,Yan %A Zhao,Juanjuan %+ School of Software, Taiyuan University of Technology, No. 319, University Street, Yuji District, Jingzhong, 030600, China, 86 18636664123, zhaojuanjuan@tyut.edu.cn %K exergame %K mild cognitive impairment %K dementia %K long-term care facilities %K multicomponent training %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence is higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, older adults often lose interest in repetitive interventions. The exergame “WarioWare: Move It!” (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, and cognitive engagement into an immersive experience. Objective: This study aimed to assess the clinical efficacy of an exergame-based training program delivered via “WarioWare: Move It!” in improving physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function in older adults living in LTCFs. Methods: The training program was conducted across multiple rural LTCFs in Shanxi Province, China. Participants were randomly assigned to the intervention or control group. The intervention protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, and object-mimicking postures with Joy-Con controllers. Primary outcome measures were derived through clinical tests, including the sit and reach test, shoulder flexibility test, trunk rotation flexibility test, shoulder and elbow range of motion, figure-of-8 walk test, standing balance test, hand dexterity test, and cognitive function tests. Statistical analysis was performed using mixed ANOVA, with time as the within-participant factor and intervention group as the between-participant factor, to assess the training effects on the various outcome measures. Results: A total of 232 participants were recruited, including 32 (13.8%) patients with mild dementia, 18 (7.8%) with moderate dementia, and 182 (78.4%) with mild cognitive impairment, all of whom completed the study. The mixed ANOVA revealed significant group × time interactions across multiple physical flexibility assessments, including the remaining distance between the hands and toes during the forward bend (F2,156=8.484; P<.001; η²=0.098), the distance between the hands clasped behind the back (F2,156=3.666; P=.04; η²=0.045), and the angle formed by trunk rotation to the left and right (F2,156=17.353; P<.001; η²=0.182). Significant group × time interactions also emerged for shoulder joint forward flexion (F2,156=17.655; P<.001; η²=0.185), abduction (F2,156=6.281; P=.004; η²=0.075), and elbow flexion (F2,156=3.298; P=.049; η²=0.041). In addition, the time to complete the figure-of-8 walk test (F2,156=11.846; P<.001; η²=0.132) and the number of blocks moved within 1 minute (F2,156=4.016; P=.02; η²=0.049) showed significant interactions. Finally, all scale-based measures exhibited statistically significant group × time interactions (all P values <.001). Conclusions: The “WarioWare: Move It!” intervention significantly improved physical flexibility, joint range of motion, motor coordination, hand dexterity, and cognitive function among older adults with mild cognitive impairment or dementia residing in rural LTCFs. The intervention offers an innovative and feasible approach for promoting the health of older adults in resource-limited settings, demonstrating its potential for widespread application in diverse low-resource environments. Trial Registration: ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971 %M 39969990 %R 10.2196/69109 %U https://www.jmir.org/2025/1/e69109 %U https://doi.org/10.2196/69109 %U http://www.ncbi.nlm.nih.gov/pubmed/39969990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55468 %T Traversing Shifting Sands—the Challenges of Caring for Someone With Alzheimer's Disease and the Impact on Care Partners: Social Media Content Analysis %A Frederiksen,Kristian Steen %A Hahn-Pedersen,Julie %A Crawford,Rebecca %A Morrison,Ross %A Jeppesen,Rose %A Doward,Lynda %A Weidner,Wendy %+ , RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, United Kingdom, 44 161 447 6000, rcrawford@rti.org %K Alzheimer disease %K caregiver %K burden %K health-related quality of life %K social media %D 2025 %7 18.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media data provide a valuable opportunity to explore the effects that Alzheimer disease (AD) has on care partners, including the aspects of providing care that have the greatest impacts on their lives and well-being and their priorities for their loved ones’ treatment. Objective: The objective of this social media review was to gain insight into the impact of caring for someone with AD, focusing particularly on impacts on psychological and emotional well-being, social functioning, daily life and ability to work, health-related quality of life, social functioning, and relationships. Methods: We reviewed social media posts from 4 sources—YouTube (Google), Alzheimer’s Association, Alzheimer Society of Canada, and Dementia UK—to gain insights into the impact of AD on care partners. English-language posts uploaded between May 2011 and May 2021 that discussed the impact of AD on care partners were included and analyzed thematically. Results: Of the 279 posts identified, 55 posts, shared by 70 contributors (4 people living with AD and 66 care partners or family members), met the review criteria. The top 3 reported or observed impacts of AD discussed by contributors were psychological and emotional well-being (53/70, 76%), social life and relationships (37/70, 53%), and care partner overall health-related quality of life (27/70, 39%). An important theme that emerged was the emotional distress and sadness (24/70, 34%) associated with the care partners’ experience of “living bereavement” or “anticipatory grief.” Contributors also reported impacts on care partners’ daily life (9/70, 13%) and work and employment (8/70, 11%). Care partners’ emotional distress was also exacerbated by loved ones’ AD-related symptoms (eg, altered behavior and memory loss). Caregiving had long-term consequences for care partners, including diminished personal well-being, family and personal sacrifices, loss of employment, and unanticipated financial burdens. Conclusions: Insights from social media emphasized the psychological, emotional, professional, and financial impacts on individuals providing informal care for a person with AD and the need for improved care partner support. A comprehensive understanding of care partners’ experiences is needed to capture the true impact of AD. %M 39965199 %R 10.2196/55468 %U https://www.jmir.org/2025/1/e55468 %U https://doi.org/10.2196/55468 %U http://www.ncbi.nlm.nih.gov/pubmed/39965199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59015 %T A New Computer-Based Cognitive Measure for Early Detection of Dementia Risk (Japan Cognitive Function Test): Validation Study %A Shimada,Hiroyuki %A Doi,Takehiko %A Tsutsumimoto,Kota %A Makino,Keitaro %A Harada,Kenji %A Tomida,Kouki %A Morikawa,Masanori %A Makizako,Hyuma %+ Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Ōbu, 474-8511, Japan, 81 0562 46 2311, shimada@ncgg.go.jp %K cognition %K neurocognitive test %K dementia %K Alzheimer disease %K aged %K MMSE %K cognitive impairment %K Mini-Mental State Examination %K monitoring %K eHealth %D 2025 %7 14.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of disease-modifying treatment options for Alzheimer disease is creating a paradigm shift in strategies to identify patients with mild symptoms in primary care settings. Systematic reviews on digital cognitive tests reported that most showed diagnostic performance comparable with that of paper-and-pencil tests for mild cognitive impairment and dementia. However, most studies have small sample sizes, with fewer than 100 individuals, and are based on case-control or cross-sectional designs. Objective: This study aimed to examine the predictive validity of the Japanese Cognitive Function Test (J-Cog), a new computerized cognitive battery test, for dementia development. Methods: We randomly assigned 2520 older adults (average age 72.7, SD 6.7 years) to derivation and validation groups to determine and validate cutoff points for the onset of dementia. The Mini-Mental State Examination (MMSE) was used for comparison purposes. The J-Cog consists of 12 tasks that assess orientation, designation, attention and calculation, mental rotation, verbal fluency, sentence completion, working memory, logical reasoning, attention, common knowledge, word memory recall, and episodic memory recall. The onset of dementia was monitored for 60 months. In the derivation group, receiver operating characteristic curves were plotted to determine the MMSE and J-Cog cutoff points that best discriminated between the groups with and without dementia. In the validation group, Cox proportional regression models were developed to predict the associations of the group classified using the cutoff points of the J-Cog or MMSE with dementia incidence. Harrell C-statistic was estimated to summarize how well a predicted risk score described an observed sequence of events. The Akaike information criterion was calculated for relative goodness of fit, where lower absolute values indicate a better model fit. Results: Significant hazard ratios (HRs) for dementia incidence were found using the MMSE cutoff between 23 and 24 point (HR 1.93, 95% CI 1.13-3.27) and the J-Cog cutoff between 43 and 44 points (HR 2.42, 95% CI 1.50-3.93). In the total validation group, the C-statistic was above 0.8 for all cutoff points. Akaike information criterion with MMSE cutoff between 23 and 24 points as a reference showed a poor fit for MMSE cutoff between 28 and 29 points, and a good fit for the J-Cog cutoff between 43 and 44 points. Conclusions: The J-Cog has higher accuracy in predicting the development of dementia than the MMSE and has advantages for use in the community as a test of cognitive function, which can be administered by nonprofessionals. %M 39951718 %R 10.2196/59015 %U https://www.jmir.org/2025/1/e59015 %U https://doi.org/10.2196/59015 %U http://www.ncbi.nlm.nih.gov/pubmed/39951718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62706 %T Acceptance of Unsupervised App-Based Cognitive Assessment in Outpatient Care: An Implementation Study %A Blotenberg,Iris %A Boekholt,Melanie %A Lieberknecht,Nils %A Säring,Paula %A Thyrian,Jochen René %K mild cognitive impairment %K Alzheimer disease %K dementia %K cognition %K computerized assessment %K digital assessment %K digital cognitive biomarkers %K home-based assessment %K digital platform %K mobile phone %D 2025 %7 13.2.2025 %9 %J JMIR Form Res %G English %X Background: The use of unsupervised digital cognitive assessments provides considerable opportunities for early and comprehensive testing for Alzheimer disease, minimizing the demand on time and personnel resources in medical practices. However, the acceptance within health care has yet to be assessed. Objective: In this implementation study, the acceptance of an app-based, repeated cognitive assessment for early symptoms of Alzheimer disease in the outpatient care setting from both physicians’ and patients’ perspectives was examined. Methods: In total, 15 primary care practices participated, where patients with self- or relative-reported memory problems could be prescribed an app (neotivCare app [neotiv GmbH]) for comprehensive cognitive testing. Patients used the app to test their episodic memory function weekly for 12 weeks at home. After the testing period and the final consultation, physicians and patients received questionnaires to assess the app’s acceptance. Results: We received completed questionnaires from physicians for 45 patients. In addition, we received 45 completed questionnaires from the patients themselves. The physicians reported that, for most patients, the app supported their decision-making in the diagnostic process (26/45, 58%). In addition, most physicians found the app’s information dependable (34/45, 76%) and felt more certain in their decisions (38/45, 84%). From the patients’ perspective, a majority felt thoroughly tested (34/45, 76%), and only a few considered the time commitment for the cognitive tests to be too burdensome (7/45, 16%). Furthermore, despite the weekly cognitive testing and the lengthy 12-week testing period, a majority of patients participated in all tests (39/54, 72%). Conclusions: Our results indicate a high level of acceptance by physicians and patients, suggesting significant potential for the implementation of unsupervised digital cognitive assessments into routine health care. In the future, acceptance should be assessed in large-scale studies, with a particular focus on the impact on health care delivery and patient outcomes. %R 10.2196/62706 %U https://formative.jmir.org/2025/1/e62706 %U https://doi.org/10.2196/62706 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 4 %N %P e64624 %T Exploring Speech Biosignatures for Traumatic Brain Injury and Neurodegeneration: Pilot Machine Learning Study %A Rubaiat,Rahmina %A Templeton,John Michael %A Schneider,Sandra L %A De Silva,Upeka %A Madanian,Samaneh %A Poellabauer,Christian %K speech biosignatures %K speech feature analysis %K amyotrophic lateral sclerosis %K ALS %K neurodegenerative disease %K Parkinson's disease %K detection %K speech %K neurological %K traumatic brain injury %K concussion %K mobile device %K digital health %K machine learning %K mobile health %K diagnosis %K mobile phone %D 2025 %7 12.2.2025 %9 %J JMIR Neurotech %G English %X Background: Speech features are increasingly linked to neurodegenerative and mental health conditions, offering the potential for early detection and differentiation between disorders. As interest in speech analysis grows, distinguishing between conditions becomes critical for reliable diagnosis and assessment. Objective: This pilot study explores speech biosignatures in two distinct neurodegenerative conditions: (1) mild traumatic brain injuries (eg, concussions) and (2) Parkinson disease (PD) as the neurodegenerative condition. Methods: The study included speech samples from 235 participants (97 concussed and 94 age-matched healthy controls, 29 PD and 15 healthy controls) for the PaTaKa test and 239 participants (91 concussed and 104 healthy controls, 29 PD and 15 healthy controls) for the Sustained Vowel (/ah/) test. Age-matched healthy controls were used. Young age-matched controls were used for concussion and respective age-matched controls for neurodegenerative participants (15 healthy samples for both tests). Data augmentation with noise was applied to balance small datasets for neurodegenerative and healthy controls. Machine learning models (support vector machine, decision tree, random forest, and Extreme Gradient Boosting) were employed using 37 temporal and spectral speech features. A 5-fold stratified cross-validation was used to evaluate classification performance. Results: For the PaTaKa test, classifiers performed well, achieving F1-scores above 0.9 for concussed versus healthy and concussed versus neurodegenerative classifications across all models. Initial tests using the original dataset for neurodegenerative versus healthy classification yielded very poor results, with F1-scores below 0.2 and accuracy under 30% (eg, below 12 out of 44 correctly classified samples) across all models. This underscored the need for data augmentation, which significantly improved performance to 60%‐70% (eg, 26‐31 out of 44 samples) accuracy. In contrast, the Sustained Vowel test showed mixed results; F1-scores remained high (more than 0.85 across all models) for concussed versus neurodegenerative classifications but were significantly lower for concussed versus healthy (0.59‐0.62) and neurodegenerative versus healthy (0.33‐0.77), depending on the model. Conclusions: This study highlights the potential of speech features as biomarkers for neurodegenerative conditions. The PaTaKa test exhibited strong discriminative ability, especially for concussed versus neurodegenerative and concussed versus healthy tasks, whereas challenges remain for neurodegenerative versus healthy classification. These findings emphasize the need for further exploration of speech-based tools for differential diagnosis and early identification in neurodegenerative health. %R 10.2196/64624 %U https://neuro.jmir.org/2025/1/e64624 %U https://doi.org/10.2196/64624 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60652 %T Uncovering Specific Navigation Patterns by Assessing User Engagement of People With Dementia and Family Caregivers With an Advance Care Planning Website: Quantitative Analysis of Web Log Data %A Dupont,Charlèss %A Smets,Tinne %A Potts,Courtney %A Monnet,Fanny %A Pivodic,Lara %A De Vleminck,Aline %A Van Audenhove,Chantal %A Mulvenna,Maurice %A Van den Block,Lieve %K dementia %K advance care planning %K user engagement %K web-based tool %K care %K website %K caregiver %K communication %K tool %K online %D 2025 %7 11.2.2025 %9 %J JMIR Aging %G English %X Background: Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. Objective: This study aimed to assess the website’s usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. Methods: We analyzed the website’s log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. Results: A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. Conclusions: The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools. %R 10.2196/60652 %U https://aging.jmir.org/2025/1/e60652 %U https://doi.org/10.2196/60652 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64445 %T Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report %A Abdulazeem,Hebatullah %A Borges do Nascimento,Israel Júnior %A Weerasekara,Ishanka %A Sharifan,Amin %A Grandi Bianco,Victor %A Cunningham,Ciara %A Kularathne,Indunil %A Deeken,Genevieve %A de Barros,Jerome %A Sathian,Brijesh %A Østengaard,Lasse %A Lamontagne-Godwin,Frederique %A van Hoof,Joost %A Lazeri,Ledia %A Redlich,Cassie %A Marston,Hannah R %A Dos Santos,Ryan Alistair %A Azzopardi-Muscat,Natasha %A Yon,Yongjie %A Novillo-Ortiz,David %+ Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Marmorvej, 51, Copenhagen, 2100, Denmark, 45 45 33 7198, dnovillo@who.int %K people living with dementia %K digital health technologies %K bibliometric analysis %K evidence-based medicine %D 2025 %7 10.2.2025 %9 Review %J JMIR Ment Health %G English %X Background: Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members. Objective: This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers. Methods: A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends. Results: A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions. Conclusions: Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally. Trial Registration: PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=511241 %M 39928936 %R 10.2196/64445 %U https://mental.jmir.org/2025/1/e64445 %U https://doi.org/10.2196/64445 %U http://www.ncbi.nlm.nih.gov/pubmed/39928936 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64847 %T Implications of Public Disclosure of Personal Information in a Mobile Alert App for People Living With Dementia Who Go Missing: Qualitative Descriptive Study %A Adekoya,Adebusola %A Daum,Christine %A Neubauer,Noelannah %A Miguel-Cruz,Antonio %A Liu,Lili %+ , School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, lili.liu@uwaterloo.ca %K alert systems %K technology %K missing persons %K dementia %K autonomy %K privacy %K stigmatization %K consent %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: People living with dementia are at risk of getting lost and going missing due to memory loss, confusion, and disorientation. Missing person incidents involving people living with dementia are increasing. Alert systems such as Community ASAP can promote community engagement in locating missing persons with dementia and aid in search and rescue efforts. However, the implications of public disclosure of personal information such as name, age, sex, and physical description within such alert systems have yet to be explored. Objective: This study aimed to identify and discuss the implications of public disclosure of personal information in Community ASAP for people living with dementia at risk of going missing. Methods: This study used a qualitative descriptive research design drawing from naturalistic inquiry. A total of 19 participants including people living with dementia, care partners, first responders, and service providers were recruited from Ontario, Alberta, and British Columbia, Canada. Semistructured interviews were used to explore participants’ perspectives on the perceived implications of the release of personal information when using Community ASAP. NVivo (version 12) was used to manage data, and conventional content analysis was conducted to identify key themes of the implications of public disclosure of personal information in Community ASAP. Results: In total, 10/19 (53%) of the participants were women and 9/19 (47%) were men. Of the 19 participants, 3 (16%) were people living with dementia, 5 (26%) were care partners, 4 (21%) were first responders, and 7 (37%) were service providers. In total, 4 key themes were identified as implications of public disclosure of personal information in Community ASAP: right to autonomy, safety versus privacy, informed and knowledgeable consent, and stigmatization. Participants discussed how the public disclosure of personal information in Community ASAP could undermine a person’s choice not to be found and contribute to stigmatization. Participants emphasized a need to balance safety and privacy concerns. Informed and knowledgeable consent is important when using an alert system to locate missing persons with dementia. Conclusions: Community ASAP can promote community engagement in locating missing persons with dementia. However, the public disclosure of personal information in alert systems has implications. Users’ right to autonomy, a balance between safety and privacy, informed and knowledgeable consent, and risks of stigmatization are perceived impacts of disclosure of personal information in alert systems. %M 39918846 %R 10.2196/64847 %U https://aging.jmir.org/2025/1/e64847 %U https://doi.org/10.2196/64847 %U http://www.ncbi.nlm.nih.gov/pubmed/39918846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62647 %T Detection of Alzheimer Disease in Neuroimages Using Vision Transformers: Systematic Review and Meta-Analysis %A Mubonanyikuzo,Vivens %A Yan,Hongjie %A Komolafe,Temitope Emmanuel %A Zhou,Liang %A Wu,Tao %A Wang,Nizhuan %+ , Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, Kowloon, 999077, China (Hong Kong), 852 27667681, wangnizhuan1120@gmail.com %K diagnostic accuracy %K vision transformer %K Alzheimer disease %K detection %K neuroimaging, meta-analysis %K neuroimaging %K deep learning %K medical database %K diagnostic %K clinical implementation %K machine learning %K magnetic resonance imaging %K neural networks %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Alzheimer disease (AD) is a progressive condition characterized by cognitive decline and memory loss. Vision transformers (ViTs) are emerging as promising deep learning models in medical imaging, with potential applications in the detection and diagnosis of AD. Objective: This review systematically examines recent studies on the application of ViTs in detecting AD, evaluating the diagnostic accuracy and impact of network architecture on model performance. Methods: We conducted a systematic search across major medical databases, including China National Knowledge Infrastructure, CENTRAL (Cochrane Central Register of Controlled Trials), ScienceDirect, PubMed, Web of Science, and Scopus, covering publications from January 1, 2020, to March 1, 2024. A manual search was also performed to include relevant gray literature. The included papers used ViT models for AD detection versus healthy controls based on neuroimaging data, and the included studies used magnetic resonance imaging and positron emission tomography. Pooled diagnostic accuracy estimates, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratios, were derived using random-effects models. Subgroup analyses comparing the diagnostic performance of different ViT network architectures were performed. Results: The meta-analysis, encompassing 11 studies with 95% CIs and P values, demonstrated pooled diagnostic accuracy: sensitivity 0.925 (95% CI 0.892-0.959; P<.01), specificity 0.957 (95% CI 0.932-0.981; P<.01), positive likelihood ratio 21.84 (95% CI 12.26-38.91; P<.01), and negative likelihood ratio 0.08 (95% CI 0.05-0.14; P<.01). The area under the curve was notably high at 0.924. The findings highlight the potential of ViTs as effective tools for early and accurate AD diagnosis, offering insights for future neuroimaging-based diagnostic approaches. Conclusions: This systematic review provides valuable evidence for the utility of ViT models in distinguishing patients with AD from healthy controls, thereby contributing to advancements in neuroimaging-based diagnostic methodologies. Trial Registration: PROSPERO CRD42024584347; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=584347 %M 39908541 %R 10.2196/62647 %U https://www.jmir.org/2025/1/e62647 %U https://doi.org/10.2196/62647 %U http://www.ncbi.nlm.nih.gov/pubmed/39908541 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66017 %T Effectiveness of a Dyadic Technology–Enhanced Home-Based Horticultural Therapy on Psychosocial Well-Being Among People With Dementia and Their Family Caregivers: Multimethods Pilot Study %A Kor,Patrick Pui Kin %A Liu,Justina Yat Wa %A Wong,Arkers Kwan Ching %A Tsang,Alex Pak Lik %A Tan,Han Zhi %A Cheung,Daphne Sze Ki %A Leung,Humphrey Kwong Wai %A Wong,Frances Kam Yuet %+ School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 27665622, patrick.kor@polyu.edu.hk %K horticultural activity %K dementia %K caregivers %K dyadic intervention %K technology–enhanced intervention %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Horticultural therapy (HT) has been proposed to be an effective intervention for improving the psychosocial well-being of people with dementia and their caregivers. However, constraints such as limited land space in high-density cities, unstable weather, and lack of gardening experience may hamper the delivery of HT to people with dementia and their caregivers. Objective: This pilot study aimed to examine the feasibility and preliminary effects of a technology-enhanced home-based HT for people with dementia and their caregivers using a hydroponic indoor growing system. Methods: A single-group pre-post design was adopted. A total of 37 dyads of people with dementia and their caregivers participated in 3 weekly face-to-face sessions, followed by 8 weeks of home-based horticultural activities. Outcomes were measured at baseline and postintervention (at week 11), including feasibility outcomes, cognitive function, neuropsychiatric symptoms, and happiness levels of people with dementia. Caregivers’ outcomes included positive aspects of caregiving, perceived stress levels, depressive symptoms, caregiver distress, and happiness levels. Semistructured focus group interviews were conducted with the caregivers to further explore their horticultural experience. Results: Intervention feasibility was established with a completion rate of 83.78% and an attrition rate of 2.63% (n=1). Significant improvements were detected in caregiver distress (P<.05) and the happiness level of people with dementia (P<.01). The qualitative findings indicated that HT improved the psychological well-being of both people with dementia and caregivers, enhanced the relationships between caregivers and people with dementia, expanded the caregivers’ social networks, and enhanced the autobiographical memory of people with dementia. Conclusions: This pilot study provides evidence on the feasibility of using a hydroponic indoor grower to conduct home-based HT for people with dementia and their caregivers. The findings suggest positive effects on the psychological well-being of both people with dementia and their caregivers. Caregivers reported potential positive effects of HT on the autobiographical memory retrieval of people with dementia. Due to the pilot nature of this study, a control group was not employed. Therefore, large-scale randomized controlled trials are encouraged to further confirm the effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05577975; https://clinicaltrials.gov/study/NCT05577975 %M 39908077 %R 10.2196/66017 %U https://aging.jmir.org/2025/1/e66017 %U https://doi.org/10.2196/66017 %U http://www.ncbi.nlm.nih.gov/pubmed/39908077 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64033 %T Association of Subjective Cognitive Concerns With Performance on Mobile App–Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study %A Nester,Caroline O %A De Vito,Alyssa N %A Prieto,Sarah %A Kunicki,Zachary J %A Strenger,Jennifer %A Harrington,Karra D %A Roque,Nelson %A Sliwinski,Martin J %A Rabin,Laura A %A Thompson,Louisa I %K subjective cognitive concerns %K subjective cognitive decline %K digital cognitive assessment %K mobile app %K app-based %K preclinical Alzheimer disease %K mild cognitive impairment %K MCI %K preclinical dementia %K mobile monitoring of cognitive change %K Cognitive Function Instrument %K mHealth %K mobile health %K applications %K cognition %K assessment %K remote %K geriatrics %K gerontology %K aging %K memory %K older adult %K elderly %K digital health %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Aging %G English %X Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app–based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=−.20, P=.37, 95% CI −.65 to −.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=−.20, P=.02, 95% CI −.02 to −.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=−1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. %R 10.2196/64033 %U https://aging.jmir.org/2025/1/e64033 %U https://doi.org/10.2196/64033 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e66104 %T Comparison of 3 Aging Metrics in Dual Declines to Capture All-Cause Dementia and Mortality Risk: Cohort Study %A Bai,Anying %A He,Shan %A Jiang,Yu %A Xu,Weihao %A Lin,Zhanyi %K gerontology %K geriatrics %K older adults %K older people %K aging %K motoric cognitive risk syndrome %K MCR %K physio-cognitive decline syndrome %K PCDS %K cognitive frailty %K CF %K frailty %K discrimination %K risk factors %K prediction %K dementia risk %K mortality risk %D 2025 %7 30.1.2025 %9 %J JMIR Aging %G English %X Background: The utility of aging metrics that incorporate cognitive and physical function is not fully understood. Objective: We aim to compare the predictive capacities of 3 distinct aging metrics—motoric cognitive risk syndrome (MCR), physio-cognitive decline syndrome (PCDS), and cognitive frailty (CF)—for incident dementia and all-cause mortality among community-dwelling older adults. Methods: We used longitudinal data from waves 10-15 of the Health and Retirement Study. Cox proportional hazards regression analysis was employed to evaluate the effects of MCR, PCDS, and CF on incident all-cause dementia and mortality, controlling for socioeconomic and lifestyle factors, as well as medical comorbidities. Discrimination analysis was conducted to assess and compare the predictive accuracy of the 3 aging metrics. Results: A total of 2367 older individuals aged 65 years and older, with no baseline prevalence of dementia or disability, were ultimately included. The prevalence rates of MCR, PCDS, and CF were 5.4%, 6.3%, and 1.3%, respectively. Over a decade-long follow-up period, 341 cases of dementia and 573 deaths were recorded. All 3 metrics were predictive of incident all-cause dementia and mortality when adjusting for multiple confounders, with variations in the strength of their associations (incident dementia: MCR odds ratio [OR] 1.90, 95% CI 1.30‐2.78; CF 5.06, 95% CI 2.87‐8.92; PCDS 3.35, 95% CI 2.44‐4.58; mortality: MCR 1.60, 95% CI 1.17‐2.19; CF 3.26, 95% CI 1.99‐5.33; and PCDS 1.58, 95% CI 1.17‐2.13). The C-index indicated that PCDS and MCR had the highest discriminatory accuracy for all-cause dementia and mortality, respectively. Conclusions: Despite the inherent differences among the aging metrics that integrate cognitive and physical functions, they consistently identified risks of dementia and mortality. This underscores the importance of implementing targeted preventive strategies and intervention programs based on these metrics to enhance the overall quality of life and reduce premature deaths in aging populations. %R 10.2196/66104 %U https://aging.jmir.org/2025/1/e66104 %U https://doi.org/10.2196/66104 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e62914 %T Preclinical Cognitive Markers of Alzheimer Disease and Early Diagnosis Using Virtual Reality and Artificial Intelligence: Literature Review %A Scribano Parada,María de la Paz %A González Palau,Fátima %A Valladares Rodríguez,Sonia %A Rincon,Mariano %A Rico Barroeta,Maria José %A García Rodriguez,Marta %A Bueno Aguado,Yolanda %A Herrero Blanco,Ana %A Díaz-López,Estela %A Bachiller Mayoral,Margarita %A Losada Durán,Raquel %K dementia %K Alzheimer disease %K mild cognitive impairment %K virtual reality %K artificial intelligence %K early detection %K qualitative review %K literature review %K AI %D 2025 %7 28.1.2025 %9 %J JMIR Med Inform %G English %X Background: This review explores the potential of virtual reality (VR) and artificial intelligence (AI) to identify preclinical cognitive markers of Alzheimer disease (AD). By synthesizing recent studies, it aims to advance early diagnostic methods to detect AD before significant symptoms occur. Objective: Research emphasizes the significance of early detection in AD during the preclinical phase, which does not involve cognitive impairment but nevertheless requires reliable biomarkers. Current biomarkers face challenges, prompting the exploration of cognitive behavior indicators beyond episodic memory. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched Scopus, PubMed, and Google Scholar for studies on neuropsychiatric disorders utilizing conversational data. Results: Following an analysis of 38 selected articles, we highlight verbal episodic memory as a sensitive preclinical AD marker, with supporting evidence from neuroimaging and genetic profiling. Executive functions precede memory decline, while processing speed is a significant correlate. The potential of VR remains underexplored, and AI algorithms offer a multidimensional approach to early neurocognitive disorder diagnosis. Conclusions: Emerging technologies like VR and AI show promise for preclinical diagnostics, but thorough validation and regulation for clinical safety and efficacy are necessary. Continued technological advancements are expected to enhance early detection and management of AD. %R 10.2196/62914 %U https://medinform.jmir.org/2025/1/e62914 %U https://doi.org/10.2196/62914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59663 %T Long-Term Impact of Using Mobile Phones and Playing Computer Games on the Brain Structure and the Risk of Neurodegenerative Diseases: Large Population-Based Study %A Xiao,Yi %A Zhang,Sirui %A Ma,Yuanzheng %A Wang,Shichan %A Li,Chunyu %A Liang,Yan %A Shang,Huifang %+ Department of Neurology, West China Hospital, Sichuan University, No.17, Section 3, Renmin South Road, Chengdu, China, 86 18980602127, hfshang2002@126.com %K electronic device %K parkinsonism %K dementia %K aging %K brain MRI %K magnetic resonance imaging %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing popularity of electronic devices, the longitudinal effects of daily prolonged electronic device usage on brain health and the aging process remain unclear. Objective: The aim of this study was to investigate the impact of the daily use of mobile phones/computers on the brain structure and the risk of neurodegenerative diseases. Methods: We used data from the UK Biobank, a longitudinal population-based cohort study, to analyze the impact of mobile phone use duration, weekly usage time, and playing computer games on the future brain structure and the future risk of various neurodegenerative diseases, including all-cause dementia (ACD), Alzheimer disease (AD), vascular dementia (VD), all-cause parkinsonism (ACP), and Parkinson disease (PD). All the characteristics of using mobile phones and playing computer games were collected through face-to-face interviews at baseline, and outcomes were extracted from the algorithmic combinations of self-reported medical conditions, hospital admissions, and death registries. In addition, a group of participants underwent magnetic resonance imaging (MRI) at follow-up. Cox regression and linear regression were performed. Results: The study included over 270,000 participants for risk analysis, with a mean baseline age of approximately 55.85 (SD 8.07) years. The average follow-up duration was approximately 13.9 (SD 1.99) years. Lengthy mobile phone use was associated with a reduced risk of ACD (2-4 years: hazard ratio [HR] 0.815, 95% CI 0.729-0.912, P<.001; 5-8 years: HR 0.749, 95% CI 0.677-0.829, P<.001; >8 years: HR 0.830, 95% CI 0.751-0.918, P<.001), AD (5-8 years: HR 0.787, 95% CI 0.672-0.922, P=.003), and VD (2-4 years: HR 0.616, 95% CI 0.477-0.794, P<.001; 5-8 years: HR 0.729, 95% CI 0.589-0.902, P=.004; >8 years: HR 0.750, 95% CI 0.605-0.930, P=.009) compared to rarely using mobile phones. Additionally, lengthy mobile phone use was linked to a decreased risk of ACP (5-8 years: HR 0.747, 95% CI 0.637-0.875, P<.001; >8 years: HR 0.774, 95% CI 0.663-0.904, P=.001) and PD (5-8 years: HR 0.760, 95% CI 0.644-0.897, P=.001; >8 years: HR 0.777, 95% CI 0.660-0.913, P=.002) in participants older than 60 years. However, higher weekly usage time did not confer additional risk reduction compared to lower weekly usage of mobile phones. The neuroimaging analysis involved 35,643 participants, with an average duration of approximately 9.0 years between baseline and neuroimaging scans. Lengthy mobile phone use was related to a thicker cortex in different areas of the brain. Conclusions: Lengthy mobile phone use is associated with a reduced risk of neurodegenerative diseases and improved brain structure compared to minimal usage. Our research provides valuable background knowledge for future studies on the impact of modern electronic devices on brain health. %M 39874583 %R 10.2196/59663 %U https://www.jmir.org/2025/1/e59663 %U https://doi.org/10.2196/59663 %U http://www.ncbi.nlm.nih.gov/pubmed/39874583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64718 %T Internet-Based Dementia Prevention Intervention (DementiaRisk): Protocol for a Randomized Controlled Trial and Knowledge Translation %A Levinson,Anthony J %A Ayers,Stephanie %A Clark,Sandra %A Woodburn,Rebekah %A Dobbins,Maureen %A Duarte,Dante %A Grad,Roland %A Kates,Nick %A Marr,Sharon %A Oliver,Doug %A Papaioannou,Alexandra %A Saperson,Karen %A Siu,Henry %A Strudwick,Gillian %A Sztramko,Richard %A Neil-Sztramko,Sarah %+ McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada, 1 905 525 9140, levinsa@mcmaster.ca %K web-based intervention %K internet %K eHealth %K dementia risk %K dementia prevention %K Alzheimer disease %K education and training %K clinical trial %K knowledge translation %K public health %K health literacy %K e-learning %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research has shown that engaging in a range of healthy lifestyles or behavioral factors can help reduce the risk of developing dementia. Improved knowledge of modifiable risk factors for dementia may help engage people to reduce their risk, with beneficial impacts on individual and public health. Moreover, many guidelines emphasize the importance of providing education and web-based resources for dementia prevention. Internet-based interventions may be effective, but few have been studied rigorously or widely disseminated. We created DementiaRisk, an award-winning, web- and email-based education platform for the public focused on modifiable risk factors, featuring multimedia e-learning and email “microlearning” content, to help raise awareness and improve knowledge of actions to reduce dementia risk. Objective: This protocol describes a randomized controlled trial to (1) evaluate whether exposure to DementiaRisk changes knowledge of dementia risk factors, intention to engage in risk reduction activities, and health behaviors related to dementia risk reduction and to (2) explore qualitative aspects including participants’ engagement and satisfaction with the intervention and barriers and facilitators to use. Methods: Using a sequential explanatory mixed methods design, this study conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. In total, 485 participants will be recruited on the web and randomly assigned to 2 groups: one accessing DementiaRisk and the other receiving alternative e-learning on mild cognitive impairment. Assessments will be delivered on the web at baseline (T1), at 4 weeks (T2), and at 2 months after the intervention (T3). Knowledge will be assessed using items from the Dementia Knowledge Assessment Scale, intentions to engage in risk reduction activities will be assessed using items in line with current evidence, and health behaviors related to dementia risk reduction will be assessed using items from the Godin-Shephard Leisure Time Physical Activity Questionnaire along with additional questions related to a range of health status domains. Outcomes and feasibility will be assessed using the Information Assessment Method for patients and consumers. A linear mixed effects model will be used to examine the relationship between each outcome score by group and time point. Results: This study was approved by the Hamilton Integrated Research Ethics Board on August 24, 2022 (project ID 14886) and received funding in February 2023. Recruitment took place from March 28, 2023, to April 28, 2023, with the final participants completing the intervention by August 18, 2023. Analyses and interpretation of data are ongoing. Conclusions: DementiaRisk is a readily scalable, technology-enhanced solution for dementia prevention education. It has been designed using evidence-based principles of multimedia learning. It has the potential to scale and spread widely using the open internet, so it may be able to reach a wider audience than traditional in-person educational interventions. Trial Registration: ClinicalTrials.gov NCT05383118; https://clinicaltrials.gov/study/NCT05383118 International Registered Report Identifier (IRRID): DERR1-10.2196/64718 %M 39869903 %R 10.2196/64718 %U https://www.researchprotocols.org/2025/1/e64718 %U https://doi.org/10.2196/64718 %U http://www.ncbi.nlm.nih.gov/pubmed/39869903 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65022 %T A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study %A Zeiler,Michael %A Dietzel,Nikolas %A Haug,Fabian %A Haug,Julian %A Kammerer,Klaus %A Pryss,Rüdiger %A Heuschmann,Peter %A Graessel,Elmar %A Kolominsky-Rabas,Peter L %A Prokosch,Hans-Ulrich %K dementia %K usability %K development %K digiDEM %K cognitive impairment %K older adults %K aging %K mobile health %K mHealth %K design %K feedback %K screening %K user centred %K cognitive disorder %K user-centered %K mobile app %D 2025 %7 22.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams’ experiences. The prototype was tested in several iterations by various end users and continuously improved. The app’s usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. %R 10.2196/65022 %U https://humanfactors.jmir.org/2025/1/e65022 %U https://doi.org/10.2196/65022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56310 %T Attitudes of German General Practitioners Toward eHealth Apps for Dementia Risk Reduction: Qualitative Interview Study %A Schultz,Adrian %A Luppa,Melanie %A Bleckwenn,Markus %A Riedel-Heller,Steffi G %A Zuelke,Andrea %+ Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Philipp Rosenthal Str. 55, Leipzig, 04103, Germany, 49 03419715483, andrea.zuelke@medizin.uni-leipzig.de %K eHealth %K dementia %K primary care %K lifestyle %K risk factor %K older adults %K prevention %K brain health %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions constitute a promising approach to disease prevention, particularly because of their ability to facilitate lifestyle changes. Although a rather recent development, eHealth interventions might be able to promote brain health and reduce dementia risk in older adults. Objective: This study aimed to explore the perspective of general practitioners (GPs) on the potentials and barriers of eHealth interventions for brain health. Understanding the perspective of GPs allows us to identify chances and challenges for implementing eHealth apps for dementia risk reduction. Methods: We conducted semistructured expert interviews with 9 GPs working in an outpatient setting in and near Leipzig, Germany. Data were fully transcribed and analyzed using a process model of qualitative content analysis with codes and categories being constructed inductively and deductively. Results: We found generally favorable but balanced views of eHealth apps for brain health. Eight themes were identified and elaborated on in the data as follows: “addressing dementia,” “knowledge about dementia,” “need for information,” “potential for prevention,” “chances for apps for prevention,” “development of apps for prevention,” and “barriers of apps for prevention.” GPs talked mostly about how and when to address dementia and the requirements for their use of eHealth apps for dementia prevention. GPs stated that they only addressed dementia once abnormalities were already present or less frequently when a patient or relative expressed a direct wish, while individual dementia risk or standardized diagnostic during routine check-ups were mentioned much less frequently. According to GPs, knowledge about dementia in patients was low; therefore, patients expressed little need for information on dementia risk factors and prevention in GP practices. Most patients wished for quick information regarding diagnostics, treatment options, and progression of the disease. GPs mentioned a lack of overview of the available eHealth apps and their content. They also expressed a fear of inducing health anxiety when talking to patients about risk factors and prevention. Conclusions: GPs want patients to receive relevant and individualized information. Prerequisites for the use of eHealth apps for dementia prevention were app characteristics related to design and content. GPs need to address dementia more routinely, assess relevant risk factors, and aid patients in a preventive role. Concerns were expressed over limited effectiveness, overwhelming patients, limited use in clinical practice, and only targeting patients with an already low risk of dementia. %M 39841983 %R 10.2196/56310 %U https://formative.jmir.org/2025/1/e56310 %U https://doi.org/10.2196/56310 %U http://www.ncbi.nlm.nih.gov/pubmed/39841983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53737 %T Completeness of Telehealth Interventions Reporting in Randomized Controlled Trials for Caregivers of People With Dementia: Systematic Review %A Zhu,Ling %A Xing,Yurong %A Xu,Wenhui %A Jia,Hongfei %A Wang,Xiaoxiao %A Liu,Shiqing %A Ding,Yaping %+ Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, NanJing, 211166, China, 86 13851646554, dingyp@njmu.edu.cn %K telehealth %K intervention reporting %K dementia %K caregivers %K Template for Intervention Description and Replication %K TIDieR-Telehealth checklist %D 2025 %7 20.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Telehealth interventions can effectively support caregivers of people with dementia by providing care and improving their health outcomes. However, to successfully translate research into clinical practice, the content and details of the interventions must be sufficiently reported in published papers. Objective: This study aims to evaluate the completeness of a telehealth intervention reporting in randomized controlled trials (RCTs) conducted for caregivers of people with dementia. Methods: A systematic search of relevant papers was conducted on July 26, 2023, in 9 electronic databases. RCTs of telehealth interventions for caregivers of people with dementia were included. Two independent researchers extracted the descriptive information and assessed the methodological quality (Cochrane risk of bias tool) and the completeness of reporting of the intervention by using the Template for Intervention Description and Replication (TIDieR)-Telehealth checklist, which consists of 12 items. Results: Thirty-eight eligible RCTs were included finally, and the overall quality of the studies was assessed as moderate. None of the studies completely reported all the TIDieR-Telehealth items. The most frequently reported items were the brief trial name (35/38, 92%), rationale (38/38, 100%), materials and procedures (35/38, 92%), and the modes of delivery (34/38, 90%). The least reported items were the type of location (0/38, 0%), modifications (4/38, 11%), and assessment and improvement of fidelity (9/38, 24%). Conclusions: Many details of the telehealth interventions in RCTs are reported incompletely. Greater adherence to the TIDieR-Telehealth checklist is essential for improving the reporting quality and for facilitating replicability, which has substantial implications for translation into clinical practice. %M 39832360 %R 10.2196/53737 %U https://www.jmir.org/2025/1/e53737 %U https://doi.org/10.2196/53737 %U http://www.ncbi.nlm.nih.gov/pubmed/39832360 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e60250 %T A Dynamic Adaptive Ensemble Learning Framework for Noninvasive Mild Cognitive Impairment Detection: Development and Validation Study %A Li,Aoyu %A Li,Jingwen %A Hu,Yishan %A Geng,Yan %A Qiang,Yan %A Zhao,Juanjuan %+ School of Software, Taiyuan University of Technology, No. 319, University Street, Yuji District, Jingzhong, 030600, China, 86 18636664123, zhaojuanjuan@tyut.edu.cn %K mild cognitive impairment %K ensemble learning %K harmony search %K combination optimization %K digital cognitive assessment %K physiological signal %K cognitive impairment %K detection %K machine learning %K cognitive metrics %K photoplethysmography %K neurodegenerative %K Alzheimer %K cognitive decline %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: The prompt and accurate identification of mild cognitive impairment (MCI) is crucial for preventing its progression into more severe neurodegenerative diseases. However, current diagnostic solutions, such as biomarkers and cognitive screening tests, prove costly, time-consuming, and invasive, hindering patient compliance and the accessibility of these tests. Therefore, exploring a more cost-effective, efficient, and noninvasive method to aid clinicians in detecting MCI is necessary. Objective: This study aims to develop an ensemble learning framework that adaptively integrates multimodal physiological data collected from wearable wristbands and digital cognitive metrics recorded on tablets, thereby improving the accuracy and practicality of MCI detection. Methods: We recruited 843 participants aged 60 years and older from the geriatrics and neurology departments of our collaborating hospitals, who were randomly divided into a development dataset (674/843 participants) and an internal test dataset (169/843 participants) at a 4:1 ratio. In addition, 226 older adults were recruited from 3 external centers to form an external test dataset. We measured their physiological signals (eg, electrodermal activity and photoplethysmography) and digital cognitive parameters (eg, reaction time and test scores) using the clinically certified Empatica 4 wristband and a tablet cognitive screening tool. The collected data underwent rigorous preprocessing, during which features in the time, frequency, and nonlinear domains were extracted from individual physiological signals. To address the challenges (eg, the curse of dimensionality and increased model complexity) posed by high-dimensional features, we developed a dynamic adaptive feature selection optimization algorithm to identify the most impactful subset of features for classification performance. Finally, the accuracy and efficiency of the classification model were improved by optimizing the combination of base learners. Results: The experimental results indicate that the proposed MCI detection framework achieved classification accuracies of 88.4%, 85.5%, and 84.5% on the development, internal test, and external test datasets, respectively. The area under the curve for the binary classification task was 0.945 (95% CI 0.903-0.986), 0.912 (95% CI 0.859-0.965), and 0.904 (95% CI 0.846-0.962) on these datasets. Furthermore, a statistical analysis of feature subsets during the iterative modeling process revealed that the decay time of skin conductance response, the percentage of continuous normal-to-normal intervals exceeding 50 milliseconds, the ratio of low-frequency to high-frequency (LF/HF) components in heart rate variability, and cognitive time features emerged as the most prevalent and effective indicators. Specifically, compared with healthy individuals, patients with MCI exhibited a longer skin conductance response decay time during cognitive testing (P<.001), a lower percentage of continuous normal-to-normal intervals exceeding 50 milliseconds (P<.001), and higher LF/HF (P<.001), accompanied by greater variability. Similarly, patients with MCI took longer to complete cognitive tests than healthy individuals (P<.001). Conclusions: The developed MCI detection framework has demonstrated exemplary performance and stability in large-scale validations. It establishes a new benchmark for noninvasive, effective early MCI detection that can be integrated into routine wearable and tablet-based assessments. Furthermore, the framework enables continuous and convenient self-screening within home or nonspecialized settings, effectively mitigating underresourced health care and geographic location constraints, making it an essential tool in the current fight against neurodegenerative diseases. %R 10.2196/60250 %U https://medinform.jmir.org/2025/1/e60250 %U https://doi.org/10.2196/60250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59291 %T Recruitment Challenges and Strategies in a Technology-Based Intervention for Dementia Caregivers: Descriptive Study %A Ko,Eunjung %A Gao,Ye %A Wang,Peng %A Wijayasingha,Lahiru %A Wright,Kathy D %A Gordon,Kristina C %A Wang,Hongning %A Stankovic,John A %A Rose,Karen M %K recruitment challenges and strategies %K technology-based intervention %K dementia caregivers %K dementia %K mobile phone %K Alzheimer disease %K smart health %D 2025 %7 17.1.2025 %9 %J JMIR Form Res %G English %X Background: Researchers have encountered challenges in recruiting unpaid caregivers of people living with Alzheimer disease and related dementias for intervention studies. However, little is known about the reasons for nonparticipation in in-home smart health interventions in community-based settings. Objective: This study aimed to (1) assess recruitment rates in a smart health technology intervention for caregivers of people living with Alzheimer disease and related dementias and reasons for nonparticipation among them and (2) discuss lessons learned from recruitment challenges and strategies to improve recruitment. Methods: The smart health intervention was a 4-month, single-arm trial designed to evaluate an in-home, technology-based intervention that monitors stressful moments for caregiving dyads through acoustic signals and to provide the caregivers with real-time stress management strategies. The recruitment involved two main methods: on-site engagement by a recruiter from a memory clinic and social media advertising. Caregivers were screened for eligibility by phone between January 2021 and September 2023. The recruitment rates, reasons for nonparticipation, and participant demographics were analyzed using descriptive statistics. Results: Of 201 caregivers contacted, 11 were enrolled in this study. Eighty-two caregivers did not return the screening call, and others did not participate due to privacy concerns (n=30), lack of interest (n=29), and burdensome study procedures (n=26). Our recruitment strategies included addressing privacy concerns, visualizing collected data through a dashboard, boosting social media presence, increasing the recruitment budget, updating advertisements, and preparing and deploying additional study devices. Conclusions: This study highlighted barriers to participation in the smart health intervention. Despite several recruitment strategies, enrollment rates remained below expectations. These findings underscore the need for future research to explore alternative methods for increasing the recruitment of informal dementia caregivers in technology-based intervention studies. Trial Registration: ClinicalTrials.gov NCT04536701; https://clinicaltrials.gov/study/NCT04536701 International Registered Report Identifier (IRRID): RR2-10.1111/jan.14714 %R 10.2196/59291 %U https://formative.jmir.org/2025/1/e59291 %U https://doi.org/10.2196/59291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54460 %T Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study %A Weidinger,Florian %A Dietzel,Nikolas %A Graessel,Elmar %A Prokosch,Hans-Ulrich %A Kolominsky-Rabas,Peter %K dementia %K mild cognitive impairment %K cognitive impairment %K information sources %K health information %K health information–seeking behavior %K Digital Dementia Registry Bavaria %K digiDEM %D 2025 %7 15.1.2025 %9 %J JMIR Form Res %G English %X Background: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information–seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information–seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context. Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression. Methods: This study is part of the ongoing project “Digital Dementia Registry Bavaria – digiDEM Bayern.” The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group. Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were “Personal visit to a medical professional” (mean 3.9, SD 1.1) and “Family / Friends” (mean 3.9, SD 1.2). “Internet” was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources “Internet” (F2,921=61.23; P<.001), “Courses / Lectures” (F2,921=18.88; P<.001), and “Family / Friends” (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as “Internet” (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were “TV / Radio” and “Family / Friends,” with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from “Internet” (mean difference=0.4; t685=4.97; P<.001). Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-043473 %R 10.2196/54460 %U https://formative.jmir.org/2025/1/e54460 %U https://doi.org/10.2196/54460 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60382 %T A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia %A McCage,Sydney %A Walker,Kristin %A Cornelius,Talea %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Brad %A Ritchie,Christine %A Vranceanu,Ana-Maria %A Bannon,Sarah %+ Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, Annex B-12, New York, NY, 10029, United States, 1 212 241 6866, sarah.bannon@mountsinai.org %K dementia %K dyad %K emotional distress %K intervention %K diagnosis %K telehealth %K resilient %K dyadic intervention %K care-partner %K Alzheimer’s disease %K ADRD %K psychosocial %K depression %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners—together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis. Objective: This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial. Methods: All study procedures will be conducted on the web (via phone and health care system–supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial. Results: This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024. Conclusions: We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs. International Registered Report Identifier (IRRID): DERR1-10.2196/60382 %M 39814366 %R 10.2196/60382 %U https://www.researchprotocols.org/2025/1/e60382 %U https://doi.org/10.2196/60382 %U http://www.ncbi.nlm.nih.gov/pubmed/39814366 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 4 %N %P e64182 %T Transforming Perceptions: Exploring the Multifaceted Potential of Generative AI for People With Cognitive Disabilities %A Hadar Souval,Dorit %A Haber,Yuval %A Tal,Amir %A Simon,Tomer %A Elyoseph,Tal %A Elyoseph,Zohar %K generative artificial intelligence %K cognitive disability %K social participation %K AI ethics %K assistive technology %K cognitive disorder %K societal barriers %K social inclusion %K disability study %K social mirror %K cognitive partner %K empowerment %K user involvement %K GenAI %K artificial intelligence %K neurotechnology %K neuroinformatics %K digital health %K health informatics %K neuroscience %K mental health %K computer science %K machine learning %D 2025 %7 15.1.2025 %9 %J JMIR Neurotech %G English %X Background: The emergence of generative artificial intelligence (GenAI) presents unprecedented opportunities to redefine conceptions of personhood and cognitive disability, potentially enhancing the inclusion and participation of individuals with cognitive disabilities in society. Objective: We aim to explore the transformative potential of GenAI in reshaping perceptions of cognitive disability, dismantling societal barriers, and promoting social participation for individuals with cognitive disabilities. Methods: This study is a critical review of current literature in disability studies, artificial intelligence (AI) ethics, and computer science, integrating insights from disability theories and the philosophy of technology. The analysis focused on 2 key aspects: GenAI as a social mirror reflecting societal values and biases, and GenAI as a cognitive partner for individuals with cognitive disabilities. Results: This paper proposes a theoretical framework for understanding the impact of GenAI on perceptions of cognitive disability. It introduces the concepts of GenAI as a “social mirror” that reflects and potentially amplifies societal biases and as a “cognitive copilot” providing personalized assistance in daily tasks, social interactions, and environmental navigation. This paper also presents a novel protocol for developing AI systems tailored to the needs of individuals with cognitive disabilities, emphasizing user involvement, ethical considerations, and the need to address both the opportunities and challenges posed by GenAI. Conclusions: Although GenAI has great potential for promoting the inclusion and empowerment of individuals with cognitive disabilities, realizing this potential requires a change in societal attitudes and development practices. This paper calls for interdisciplinary collaboration and close partnership with the disability community in the development and implementation of GenAI technologies. Realizing the potential of GenAI for promoting the inclusion and empowerment of individuals with cognitive disabilities requires a multifaceted approach. This involves a shift in societal attitudes, inclusive AI development practices that prioritize the needs and perspectives of the disability community, and ongoing interdisciplinary collaboration. This paper emphasizes the importance of proceeding with caution, recognizing the ethical complexities and potential risks alongside the transformative possibilities of GenAI technology. %R 10.2196/64182 %U https://neuro.jmir.org/2025/1/e64182 %U https://doi.org/10.2196/64182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63568 %T Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study %A Kwek,Siong Peng %A Leong,Qiao Ying %A Lee,V Vien %A Lau,Ni Yin %A Vijayakumar,Smrithi %A Ng,Wei Ying %A Rai,Bina %A Raczkowska,Marlena Natalia %A Asplund,Christopher L %A Remus,Alexandria %A Ho,Dean %+ Yong Loo Lin School of Medicine, Heat Resilience & Performance Centre, National University of Singapore, 27 Medical Drive, #03-01, Singapore, 117510, Singapore, 65 66017766, alexandria.remus@nus.edu.sg %K older adults %K cognitive training %K digital therapeutic %K DTx %K remote %K usability %K acceptance %K interviews %K gerontology %K geriatric %K elderly %K experiences %K attitudes %K opinions %K perceptions %K perspectives %K interview %K cognition %K digital health %K qualitative %K thematic %D 2025 %7 13.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s large aging population poses significant challenges for the health care system in managing cognitive decline, underscoring the importance of identifying and implementing effective interventions. Cognitive training delivered remotely as a digital therapeutic (DTx) may serve as a scalable and accessible approach to overcoming these challenges. While previous studies indicate the potential of cognitive training as a promising solution for managing cognitive decline, understanding the attitudes and experiences of older adults toward using such DTx platforms remains relatively unexplored. Objective: This study aimed to characterize the general acceptability and user experience of CURATE.DTx, a multitasking-based DTx platform that challenges the cognitive domains of attention, problem-solving, and executive function in the Singaporean older adult population. Methods: A total of 15 older adult participants (mean age 66.1, SD 3.5 years) were recruited for a 90-minute in-person session. This session included a 30-minute playtest of CURATE.DTx, followed by a 60-minute semistructured interview to understand their overall attitudes, experience, motivation, and views of the intervention. Interviews were audio-recorded and transcribed verbatim, then analyzed using an inductive approach. Thematic analysis was used to identify emerging patterns and insights. Results: A total of 3 main themes, and their respective subthemes, emerged from the interviews: comprehension, with subthemes of instruction and task comprehension; acceptability, with subthemes of tablet usability, engagement and enjoyment, and attitude and perceived benefits; and facilitators to adoption, with subthemes of framing and aesthetics, motivation recommendations and the role of medical professionals. Our findings revealed that participants encountered some challenges with understanding certain elements of CURATE.DTx. Nevertheless, they were still highly engaged with it, finding the challenge to be enjoyable. Participants also showed a strong awareness of the importance of cognitive training and expressed a keen interest in using CURATE.DTx for this purpose, especially if recommended by medical professionals. Conclusions: Given the positive engagement and feedback obtained from Singaporean older adults on CURATE.DTx, this study can serve as a basis for future platform iterations and strategies that should be considered during implementation. Future studies should continue implementing an iterative codesign approach to ensure the broader applicability and effectiveness of interventions tailored to this demographic. %M 39805580 %R 10.2196/63568 %U https://formative.jmir.org/2025/1/e63568 %U https://doi.org/10.2196/63568 %U http://www.ncbi.nlm.nih.gov/pubmed/39805580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59195 %T Virtual Reality Interventions for Older Adults With Mild Cognitive Impairment: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Yang,Qin %A Zhang,Liuxin %A Chang,Fangyuan %A Yang,Hongyi %A Chen,Bin %A Liu,Zhao %+ School of Design, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai, 200240, China, 86 18801971294, hotlz@sjtu.edu.cn %K Alzheimer disease %K virtual reality %K VR %K mild cognitive impairment %K meta-analysis %K health care %K cognitive function %K memory %K attention %K executive function %K older adults %D 2025 %7 10.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Alzheimer disease is incurable, but it is possible to intervene and slow down the progression of dementia during periods of mild cognitive impairment (MCI) through virtual reality (VR) technology. Objective: This study aimed to analyze the effects of VR interventions on older adults with MCI. The examined outcomes include cognitive abilities, mood, quality of life, and physical fitness, including general cognitive function, memory performance, attention and information processing speed, executive function, language proficiency, visuospatial abilities, depression, daily mobility of individuals, muscle performance, and gait and balance. Methods: A total of 4 web-based databases (Web of Science, PubMed, Embase, and Ovid) were searched up to December 30, 2023, for randomized controlled trials assessing the self-reported outcomes of VR-based technology on cognition, mood, quality of life, and physical fitness in older adults (aged ≥55 years) with MCI. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk-of-bias sensitivity analysis, and subgroup analysis were performed where appropriate to explore potential moderators. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. Results: This review analyzed 18 studies involving 722 older adults with MCI. VR was delivered through different immersion levels with VR cognitive training, VR physical training, or VR cognitive-motor dual-task training. VR interventions showed significant improvements in memory (standardized mean difference [SMD] 0.2, 95% CI 0.02-0.38), attention and information processing speed (SMD 0.25, 95% CI 0.06-0.45), and executive function (SMD 0.22, 95% CI 0.02-0.42). VR without therapist involvement improved memory as well as attention and information processing speed. VR cognitive training also resulted in significant improvements in attention and information processing speed in older adults with MCI (SMD 0.31, 95% CI 0.05-0.58). In addition, immersive VR had a significant impact on improving attention and information processing speed (SMD 0.25; 95% CI 0.01-0.50) and executive function (SMD 0.25; 95% CI 0.00-0.50). However, the effects of the intervention were very small in terms of general cognitive function, language proficiency, visuospatial abilities, depression, daily living ability, muscle performance, and gait and balance. Quality of evidence varied, with moderate ratings for certain cognitive functions and low ratings for others, based on the GRADE approach. Conclusions: VR interventions can improve memory, attention and information processing speed, and executive function in older adults with MCI. The quality of evidence is moderate to low, and further research is needed to confirm these findings and explore additional health-related outcomes. %M 39793970 %R 10.2196/59195 %U https://www.jmir.org/2025/1/e59195 %U https://doi.org/10.2196/59195 %U http://www.ncbi.nlm.nih.gov/pubmed/39793970 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60566 %T Designing a Multimodal and Culturally Relevant Alzheimer Disease and Related Dementia Generative Artificial Intelligence Tool for Black American Informal Caregivers: Cognitive Walk-Through Usability Study %A Bosco,Cristina %A Otenen,Ege %A Osorio Torres,John %A Nguyen,Vivian %A Chheda,Darshil %A Peng,Xinran %A Jessup,Nenette M %A Himes,Anna K %A Cureton,Bianca %A Lu,Yvonne %A Hill,Carl V %A Hendrie,Hugh C %A Barnes,Priscilla A %A Shih,Patrick C %+ , Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 4740, United States, 1 812 856 5754, cribosco@iu.edu %K multimodality %K artificial intelligence %K AI %K generative AI %K usability %K black %K African American %K cultural %K Alzheimer's %K dementia %K caregivers %K mobile app %K interaction %K cognition %K user opinion %K geriatrics %K smartphone %K mHealth %K digital health %K aging %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Many members of Black American communities, faced with the high prevalence of Alzheimer disease and related dementias (ADRD) within their demographic, find themselves taking on the role of informal caregivers. Despite being the primary individuals responsible for the care of individuals with ADRD, these caregivers often lack sufficient knowledge about ADRD-related health literacy and feel ill-prepared for their caregiving responsibilities. Generative AI has become a new promising technological innovation in the health care domain, particularly for improving health literacy; however, some generative AI developments might lead to increased bias and potential harm toward Black American communities. Therefore, rigorous development of generative AI tools to support the Black American community is needed. Objective: The goal of this study is to test Lola, a multimodal mobile app, which, by relying on generative AI, facilitates access to ADRD-related health information by enabling speech and text as inputs and providing auditory, textual, and visual outputs. Methods: To test our mobile app, we used the cognitive walk-through methodology, and we recruited 15 informal ADRD caregivers who were older than 50 years and part of the Black American community living within the region. We asked them to perform 3 tasks on the mobile app (ie, searching for an article on brain health, searching for local events, and finally, searching for opportunities to participate in scientific research in their area), then we recorded their opinions and impressions. The main aspects to be evaluated were the mobile app’s usability, accessibility, cultural relevance, and adoption. Results: Our findings highlight the users’ need for a system that enables interaction with different modalities, the need for a system that can provide personalized and culturally and contextually relevant information, and the role of community and physical spaces in increasing the use of Lola. Conclusions: Our study shows that, when designing for Black American older adults, a multimodal interaction with the generative AI system can allow individuals to choose their own interaction way and style based upon their interaction preferences and external constraints. This flexibility of interaction modes can guarantee an inclusive and engaging generative AI experience. %M 39778201 %R 10.2196/60566 %U https://aging.jmir.org/2025/1/e60566 %U https://doi.org/10.2196/60566 %U http://www.ncbi.nlm.nih.gov/pubmed/39778201 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63715 %T The PDC30 Chatbot—Development of a Psychoeducational Resource on Dementia Caregiving Among Family Caregivers: Mixed Methods Acceptability Study %A Cheng,Sheung-Tak %A Ng,Peter H F %+ Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, China (Hong Kong), 852 29486563, takcheng@eduhk.hk %K Alzheimer %K caregiving %K chatbot %K conversational artificial intelligence %K dementia %K digital health %K health care technology %K psychoeducational %K medical innovations %K language models %K mobile phone %D 2025 %7 6.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Providing ongoing support to the increasing number of caregivers as their needs change in the long-term course of dementia is a severe challenge to any health care system. Conversational artificial intelligence (AI) operating 24/7 may help to tackle this problem. Objective: This study describes the development of a generative AI chatbot—the PDC30 Chatbot—and evaluates its acceptability in a mixed methods study. Methods: The PDC30 Chatbot was developed using the GPT-4o large language model, with a personality agent to constrain its behavior to provide advice on dementia caregiving based on the Positive Dementia Caregiving in 30 Days Guidebook—a laypeople’s resource based on a validated training manual for dementia caregivers. The PDC30 Chatbot’s responses to 21 common questions were compared with those of ChatGPT and another chatbot (called Chatbot-B) as standards of reference. Chatbot-B was constructed using PDC30 Chatbot’s architecture but replaced the latter’s knowledge base with a collection of authoritative sources, including the World Health Organization’s iSupport, By Us For Us Guides, and 185 web pages or manuals by Alzheimer’s Association, National Institute on Aging, and UK Alzheimer’s Society. In the next phase, to assess the acceptability of the PDC30 Chatbot, 21 family caregivers used the PDC30 Chatbot for two weeks and provided ratings and comments on its acceptability. Results: Among the three chatbots, ChatGPT’s responses tended to be repetitive and not specific enough. PDC30 Chatbot and Chatbot-B, by virtue of their design, produced highly context-sensitive advice, with the former performing slightly better when the questions conveyed significant psychological distress on the part of the caregiver. In the acceptability study, caregivers found the PDC30 Chatbot highly user-friendly, and its responses quite helpful and easy to understand. They were rather satisfied with it and would strongly recommend it to other caregivers. During the 2-week trial period, the majority used the chatbot more than once per day. Thematic analysis of their written feedback revealed three major themes: helpfulness, accessibility, and improved attitude toward AI. Conclusions: The PDC30 Chatbot provides quality responses to caregiver questions, which are well-received by caregivers. Conversational AI is a viable approach to improve the support of caregivers. %R 10.2196/63715 %U https://aging.jmir.org/2025/1/e63715 %U https://doi.org/10.2196/63715 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e63464 %T Navigating Awareness and Strategies to Support Dementia Advocacy on Social Media During World Alzheimer’s Month: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah Anne %A Jamali,Ali Akbar %A Conanan,Christine %A Chasteen,Alison L %A Vellani,Shirin %A Gowda-Sookochoff,Rory %A Berger,Corinne %A Mah,Jasmine C %A Fehr,Florriann %A Virani,Anila %A Rahemi,Zahra %A Nanson,Kate %A Cammer,Allison %A Andrew,Melissa K %A Grewal,Karl S %A McGilton,Katherine S %A Lautrup,Samantha %A Spiteri,Raymond J %+ Population Health and Aging Rural Research Centre, School of Nursing, Thompson Rivers University, 805 TRU Way, Kamloops, BC, V2C 0C8, Canada, 1 1 250 371 5538, jbacsu@tru.ca %K dementia %K Alzheimer disease %K advocacy %K stigma %K myths %K awareness %K social media %K political lobbying %K lobbying %K X %K Twitter %K tweet %K thematic %K promotion %K campaign %K geriatric %K aging %D 2024 %7 27.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Understanding advocacy strategies is essential to improving dementia awareness, reducing stigma, supporting cognitive health promotion, and influencing policy to support people living with dementia. However, there is a dearth of evidence-based research on advocacy strategies used to support dementia awareness. Objective: This study aimed to use posts from X (formerly known as Twitter) to understand dementia advocacy strategies during World Alzheimer’s Awareness Month in September 2022. Methods: Posts were scraped from X during World Alzheimer’s Awareness Month from September 1, 2022, to September 30, 2022. After applying filters, 1981 relevant posts were analyzed using thematic analysis, and measures were taken to support trustworthiness and rigor. Results: Our study revealed a variety of advocacy strategies, including sharing the voices of lived experience, targeting ethnic and cultural groups, myth-busting strategies, and political lobbying. Although a range of strategies were identified, further research is needed to examine advocacy strategies within different countries and political contexts. Furthermore, the impact of specific strategies on stigma reduction, cognitive health promotion, and policy change needs to be scientifically evaluated. Conclusions: Our study offers valuable insight into strategies to bolster dementia advocacy and awareness campaigns to support people living with dementia. Findings from our research may provide critical insight for policymakers, organizations, and health professionals working to reduce dementia-related stigma and increase the uptake of risk-reduction activities to support the promotion of cognitive health. %M 39729354 %R 10.2196/63464 %U https://infodemiology.jmir.org/2024/1/e63464 %U https://doi.org/10.2196/63464 %U http://www.ncbi.nlm.nih.gov/pubmed/39729354 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e67992 %T The CareVirtue Digital Journal for Family and Friend Caregivers of People Living With Alzheimer Disease and Related Dementias: Exploratory Topic Modeling and User Engagement Study %A Pickett,Andrew C %A Valdez,Danny %A White,Lillian A %A Loganathar,Priya %A Linden,Anna %A Boutilier,Justin J %A Caldwell,Clover %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health & Wellness Design, School of Public Health- Bloomington, Indiana University, 2719 E 10th Street, Bloomington, IN, 47408, United States, 1 812 856 1710, picketac@iu.edu %K caregiving %K dementia %K social support %K technology %K intervention %K Alzheimer disease %K family %K care network %K elder %K CareVirtue %K open text %K online platform %K digital journaling tool %K computational informatics %K thematic analysis %K topic modeling %K neurodegeneration %K gerontology %K sentiment analysis %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: As Alzheimer disease (AD) and AD-related dementias (ADRD) progress, individuals increasingly require assistance from unpaid, informal caregivers to support them in activities of daily living. These caregivers may experience high levels of financial, mental, and physical strain associated with providing care. CareVirtue is a web-based tool created to connect and support multiple individuals across a care network to coordinate care activities and share important information, thereby reducing care burden. Objective: This study aims to use a computational informatics approach to thematically analyze open text written by AD/ADRD caregivers in the CareVirtue platform. We then explore relationships between identified themes and use patterns. Methods: We analyzed journal posts (n=1555 posts; 170,212 words) generated by 51 unique users of the CareVirtue platform. Latent themes were identified using a neural network approach to topic modeling. We calculated a sentiment score for each post using the Valence Aware Dictionary and Sentiment Reasoner. We then examined relationships between identified topics; semantic sentiment; and use-related data, including post word count and self-reported mood. Results: We identified 5 primary topics in users’ journal posts, including descriptions of specific events, professional and medical care, routine daily activities, nighttime symptoms, and bathroom/toileting issues. This 5-topic model demonstrated adequate fit to the data, having the highest coherence score (0.41) among those tested. We observed group differences across these topics in both word count and semantic sentiment. Further, posts made in the evening were both longer and more semantically positive than other times of the day. Conclusions: Users of the CareVirtue platform journaled about a variety of different topics, including generalized experiences and specific behavioral symptomology of AD/ADRD, suggesting a desire to record and share broadly across the care network. Posts were the most positive in the early evening when the tool was used habitually, rather than when writing about acute events or symptomology. We discuss the value of embedding informatics-based tools into digital interventions to facilitate real-time content delivery. %M 39719081 %R 10.2196/67992 %U https://aging.jmir.org/2024/1/e67992 %U https://doi.org/10.2196/67992 %U http://www.ncbi.nlm.nih.gov/pubmed/39719081 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57308 %T An Evidence-Based IT Program With Chatbot to Support Caregiving and Clinical Care for People With Dementia: The CareHeroes Development and Usability Pilot %A Ruggiano,Nicole %A Brown,Ellen Leslie %A Clarke,Peter J %A Hristidis,Vagelis %A Roberts,Lisa %A Framil Suarez,Carmen Victoria %A Allala,Sai Chaithra %A Hurley,Shannon %A Kopcsik,Chrystine %A Daquin,Jane %A Chevez,Hamilton %A Chang-Lau,Raymond %A Agronin,Marc %A Geldmacher,David S %K Alzheimer disease %K artificial intelligence %K caregivers %K chatbot %K dementia %K mobile applications %K conversational agent %K design %K apps %D 2024 %7 23.12.2024 %9 %J JMIR Aging %G English %X Background: There are numerous communication barriers between family caregivers and providers of people living with dementia, which can pose challenges to caregiving and clinical decision-making. To address these barriers, a new web and mobile-enabled app, called CareHeroes, was developed, which promotes the collection and secured sharing of clinical information between caregivers and providers. It also provides caregiver support and education. Objective: The primary study objective was to examine whether dementia caregivers would use CareHeroes as an adjunct to care and gather psychosocial data from those who used the app. Methods: This paper presents the implementation process used to integrate CareHeroes into clinical care at 2 memory clinics and preliminary outcome evaluation. Family caregivers receiving services at clinics were asked to use the app for a 12-month period to collect, track, and share clinical information with the care recipient’s provider. They also used it to assess their own mental health symptoms. Psychosocial outcomes were assessed through telephone interviews and user data were collected by the app. Results: A total of 21 caregivers enrolled in the pilot study across the 2 memory clinics. Usage data indicated that caregivers used many of the features in the CareHeroes app, though the chatbot was the most frequently used feature. Outcome data indicated that caregivers’ depression was lower at 3-month follow-up (t11=2.03, P=.03). Conclusions: Recruitment and retention of the pilot study were impacted by COVID-19 restrictions, and therefore more testing is needed with a larger sample to determine the potential impact of CareHeroes on caregivers’ mental health. Despite this limitation, the pilot study demonstrated that integrating a new supportive app for caregivers as an adjunct to clinical dementia care is feasible. Implications for future technology intervention development, implementation planning, and testing for caregivers of people living with dementia are discussed. %R 10.2196/57308 %U https://aging.jmir.org/2024/1/e57308 %U https://doi.org/10.2196/57308 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59370 %T Machine Learning Driven by Magnetic Resonance Imaging for the Classification of Alzheimer Disease Progression: Systematic Review and Meta-Analysis %A Battineni,Gopi %A Chintalapudi,Nalini %A Amenta,Francesco %+ Clinical Research, Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University Camerino, Via Madonna Delle Carceri 9, Camerino, 62032, Italy, 39 3331728206, gopi.battineni@unicam.it %K Alzheimer disease %K ML-based diagnosis %K machine learning %K prevalence %K cognitive impairment %K classification %K biomarkers %K imaging modalities %K MRI %K magnetic resonance imaging %K systematic review %K meta-analysis %D 2024 %7 23.12.2024 %9 Review %J JMIR Aging %G English %X Background: To diagnose Alzheimer disease (AD), individuals are classified according to the severity of their cognitive impairment. There are currently no specific causes or conditions for this disease. Objective: The purpose of this systematic review and meta-analysis was to assess AD prevalence across different stages using machine learning (ML) approaches comprehensively. Methods: The selection of papers was conducted in 3 phases, as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines: identification, screening, and final inclusion. The final analysis included 24 papers that met the criteria. The selection of ML approaches for AD diagnosis was rigorously based on their relevance to the investigation. The prevalence of patients with AD at 2, 3, 4, and 6 stages was illustrated through the use of forest plots. Results: The prevalence rate for both cognitively normal (CN) and AD across 6 studies was 49.28% (95% CI 46.12%-52.45%; P=.32). The prevalence estimate for the 3 stages of cognitive impairment (CN, mild cognitive impairment, and AD) is 29.75% (95% CI 25.11%-34.84%, P<.001). Among 5 studies with 14,839 participants, the analysis of 4 stages (nondemented, moderately demented, mildly demented, and AD) found an overall prevalence of 13.13% (95% CI 3.75%-36.66%; P<.001). In addition, 4 studies involving 3819 participants estimated the prevalence of 6 stages (CN, significant memory concern, early mild cognitive impairment, mild cognitive impairment, late mild cognitive impairment, and AD), yielding a prevalence of 23.75% (95% CI 12.22%-41.12%; P<.001). Conclusions: The significant heterogeneity observed across studies reveals that demographic and setting characteristics are responsible for the impact on AD prevalence estimates. This study shows how ML approaches can be used to describe AD prevalence across different stages, which provides valuable insights for future research. %M 39714089 %R 10.2196/59370 %U https://aging.jmir.org/2024/1/e59370 %U https://doi.org/10.2196/59370 %U http://www.ncbi.nlm.nih.gov/pubmed/39714089 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59865 %T Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study %A Supplieth,Juliana %A Lech,Sonia %A O’Sullivan,Julie Lorraine %A Spang,Robert %A Voigt-Antons,Jan‐Niklas %A Schuster,Johanna %K dementia %K tablet application development %K multidisciplinary health care %K feasibility study %K general practitioners %K digital health care %D 2024 %7 19.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 %R 10.2196/59865 %U https://humanfactors.jmir.org/2024/1/e59865 %U https://doi.org/10.2196/59865 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63457 %T Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis %A Chen,Jiaren %A Park,Jong-Hwan %A Lin,Chien-Yu %A Lai,Ting-Fu %A Kim,Du-Ri %A Shin,Myung-Jun %A Moon,Eunsoo %A Kang,Jung Mo %A Lee,Jong Won %A Cho,Yoon Jae %A Liao,Yung %A Goh,Tae Sik %A Lee,Jung Sub %K bioelectrical impedance analysis %K oxidative stress %K cellular health %K cognitive function %K older adults %K BIA %K phase angle %K PhA %D 2024 %7 16.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants’ whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65‐96 years (women: n=444, 71%; men: n=191, 29%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95% CI 0.16‐1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95% CI 0.38‐1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95% CI 0.00‐0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95% CI 0.09‐0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95% CI 0.10‐0.38; P<.001), attention and calculation (b=0.21, 95% CI 0.06‐0.37; P=.01), memory (b=0.14, 95% CI 0.05‐0.22; P=.001), and language functions (b=0.07, 95% CI 0.01‐0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. %R 10.2196/63457 %U https://publichealth.jmir.org/2024/1/e63457 %U https://doi.org/10.2196/63457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63041 %T Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study %A Grewal,Karl S %A Gowda-Sookochoff,Rory %A Peacock,Shelley %A Cammer,Allison %A McWilliams,Lachlan A %A Spiteri,Raymond J %A Haase,Kristen R %A Harrison,Mary %A Holtslander,Lorraine %A MacRae,Rhoda %A Michael,Joanne %A Green,Shoshana %A O'Connell,Megan E %+ Department of Psychology and Health Studies, College of Arts and Science, University of Saskatchewan, 9 Campus Drive, Sasktoon, SK, S7N 5A5, Canada, 1 3069662496, karl.grewal@usask.ca %K care partner %K caregiving %K dementia %K technology %K content analysis %K mobile phone %K technology adoption %K assistive technology %K support %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease’s impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner’s everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners’ relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners’ reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. %M 39671589 %R 10.2196/63041 %U https://formative.jmir.org/2024/1/e63041 %U https://doi.org/10.2196/63041 %U http://www.ncbi.nlm.nih.gov/pubmed/39671589 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e60155 %T The Effect of the Mediterranean Diet–Integrated Gamified Home-Based Cognitive-Nutritional (GAHOCON) Training Programme for Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Law,Queenie Pui Sze %A Tsang,Jenny Tsun Yee %A Lam,Siu Hin %A Wang,Kam To %A Sin,Olive Shuk Kan %A Cheung,Daphne Sze Ki %+ School of Nursing, Tung Wah College, Ma Kam Chan Memorial Building, 31 Wylie Road, Homantin, Hong Kong SAR, China (Hong Kong), 852 34686813, rickkwan@twc.edu.hk %K cognitive frailty %K gamification %K health education %K Mediterranean diet %K home based %K cognitive training %K older adults %K geriatric %K elderly %K cognitive training %K cognitive function %K health education %K intervention %K nutritional education %K cognitive impairment %K dementia %D 2024 %7 13.12.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=–0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=–0.728, P=.009), cognitive function (r=–0.752, P=.007), physical frailty (r=–0.668, P=.02), and walking speed (r=–0.587, P=.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930 %M 39671585 %R 10.2196/60155 %U https://rehab.jmir.org/2024/1/e60155 %U https://doi.org/10.2196/60155 %U http://www.ncbi.nlm.nih.gov/pubmed/39671585 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59584 %T Improving How Caregivers of People Living With Dementia Are Identified in the Electronic Health Record: Qualitative Study and Exploratory Chart Review %A Green,Ariel R %A Boyd,Cynthia M %A Rosado,Rosalphie Quiles %A Daddato,Andrea E %A Gleason,Kathy S %A Taylor McPhail,Tobie E %A Blinka,Marcela D %A Schoenborn,Nancy L %A Wolff,Jennifer L %A Bayliss,Elizabeth A %A Boxer,Rebecca S %K dementia %K dementia care %K caregivers %K electronic health record %K patient record %K aging %K geriatrics %K memory %D 2024 %7 13.12.2024 %9 %J JMIR Aging %G English %X Background: Family and unpaid caregivers play a crucial role in supporting people living with dementia; yet, they are not systematically identified and documented by health systems. Objective: The aims of the study are to determine the extent to which caregivers are currently identified and documented in the electronic health record (EHR) and to elicit the perspectives of caregivers and clinical staff on how to best identify, engage, and support caregivers of people living with dementia through the EHR. Methods: People with dementia were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes or dementia medications in the EHR. A chart review of people with dementia characterized how caregiver information was documented and whether caregivers had shared access to the patient portal. Caregivers of eligible people with dementia were then recruited through mailed letters and follow-up calls to the homes of people with dementia. We conducted semistructured interviews with caregivers, clinicians, and staff involved in the care of people with dementia within 2 health systems in Maryland and Colorado. Transcripts were analyzed using a mixed inductive and deductive approach. Results: Caregivers of people with dementia (N=22) were usually identified in the “contact information” or “patient contacts” tab (n=20, 91%) by their name and relation to the people with dementia; this tab did not specify the caregiver’s role. Caregivers were also mentioned, and their roles were described to a varying degree in clinical notes (n=21, 96%). Of the 22 caregivers interviewed, the majority (n=17, 77%) reported that the people with dementia had additional caregivers. The presence of multiple caregivers could be gleaned from most charts (n=16, 73%); however, this information was not captured systematically, and caregivers’ individual contributions were not explicitly recorded. Interviews with 22 caregivers and 16 clinical staff revealed two major themes: (1) caregiving arrangements are complex and not systematically captured or easy to locate in the EHR and (2) health systems should develop standardized processes to obtain and document caregiver information in the EHR. Conclusions: This exploratory chart review and qualitative interview study found that people with dementia frequently have multiple caregivers, whose roles and needs are captured inconsistently in the EHR. To address this concern, caregivers and clinical staff suggested that health systems should develop and test workflows to identify caregivers, assess their needs at multiple touchpoints, and record their information in extractable EHR fields. %R 10.2196/59584 %U https://aging.jmir.org/2024/1/e59584 %U https://doi.org/10.2196/59584 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52107 %T Early Detection of Dementia in Populations With Type 2 Diabetes: Predictive Analytics Using Machine Learning Approach %A Thanh Phuc,Phan %A Nguyen,Phung-Anh %A Nguyen,Nam Nhat %A Hsu,Min-Huei %A Le,Nguyen Quoc Khanh %A Tran,Quoc-Viet %A Huang,Chih-Wei %A Yang,Hsuan-Chia %A Chen,Cheng-Yu %A Le,Thi Anh Hoa %A Le,Minh Khoi %A Nguyen,Hoang Bac %A Lu,Christine Y %A Hsu,Jason C %+ College of Management, Taipei Medical University, 11F. Biomedical Technology Building, No. 301, Yuantong Rd., Zhonghe Dist, New Taipei, 235, Taiwan, 886 2 66202589 ext 16119, jasonhsu@tmu.edu.tw %K diabetes %K dementia %K machine learning %K prediction model %K TMUCRD %K Taipei Medical University Clinical Research Database %D 2024 %7 11.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The possible association between diabetes mellitus and dementia has raised concerns, given the observed coincidental occurrences. Objective: This study aimed to develop a personalized predictive model, using artificial intelligence, to assess the 5-year and 10-year dementia risk among patients with type 2 diabetes mellitus (T2DM) who are prescribed antidiabetic medications. Methods: This retrospective multicenter study used data from the Taipei Medical University Clinical Research Database, which comprises electronic medical records from 3 hospitals in Taiwan. This study applied 8 machine learning algorithms to develop prediction models, including logistic regression, linear discriminant analysis, gradient boosting machine, light gradient boosting machine, AdaBoost, random forest, extreme gradient boosting, and artificial neural network (ANN). These models incorporated a range of variables, encompassing patient characteristics, comorbidities, medication usage, laboratory results, and examination data. Results: This study involved a cohort of 43,068 patients diagnosed with type 2 diabetes mellitus, which accounted for a total of 1,937,692 visits. For model development and validation, 1,300,829 visits were used, while an additional 636,863 visits were reserved for external testing. The area under the curve of the prediction models range from 0.67 for the logistic regression to 0.98 for the ANNs. Based on the external test results, the model built using the ANN algorithm had the best area under the curve (0.97 for 5-year follow-up period and 0.98 for 10-year follow-up period). Based on the best model (ANN), age, gender, triglyceride, hemoglobin A1c, antidiabetic agents, stroke history, and other long-term medications were the most important predictors. Conclusions: We have successfully developed a novel, computer-aided, dementia risk prediction model that can facilitate the clinical diagnosis and management of patients prescribed with antidiabetic medications. However, further investigation is required to assess the model’s feasibility and external validity. %M 39434474 %R 10.2196/52107 %U https://www.jmir.org/2024/1/e52107 %U https://doi.org/10.2196/52107 %U http://www.ncbi.nlm.nih.gov/pubmed/39434474 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e62689 %T The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study %A Klein,Melina %A von Bosse,Alexa %A Kunze,Christophe %K touch-based digital technology %K gerontology %K geriatric %K older %K elderly %K aging %K aged %K tablet-based technology %K tablet %K digital care application %K mHealth %K mobile health %K app %K health app %K home care setting %K caring relatives %K dementia %K MCI %K Alzheimer %K mild cognitive impairment %K cognition %K prototype %K digital health %K telehealth %K dementia %K memory loss %K patient care %K patient health %K patient support %D 2024 %7 10.12.2024 %9 %J JMIR Aging %G English %X Background: The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning. Objective: This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity. Methods: We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data. Results: Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology. Conclusions: The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings. %R 10.2196/62689 %U https://aging.jmir.org/2024/1/e62689 %U https://doi.org/10.2196/62689 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63907 %T Internet-Based Social Activities and Cognitive Functioning 2 Years Later Among Middle-Aged and Older Adults: Prospective Cohort Study %A Jeon,Sangha %A Charles,Susan Turk %K online social interaction %K cognitive health %K age differences %K Health and Retirement Study %K social activity %K internet use %K isolation %D 2024 %7 10.12.2024 %9 %J JMIR Aging %G English %X Background: A number of studies document the benefits of face-to-face social interactions for cognitive functioning among middle-aged and older adults. Social activities in virtual worlds may confer similar if not enhanced cognitive benefits as face-to-face social activities, given that virtual interactions require the additional cognitive tasks of learning and navigating communicative tools and technology platforms. Yet, few studies have examined whether social activities in internet-based settings may have synergistic effects on cognitive functioning beyond those of face-to-face interactions. Objective: This study examined whether internet-based social activity participation is associated with concurrent and later cognitive functioning, after adjusting for face-to-face social activity participation and sociodemographic covariates. Methods: For cross-sectional analyses, we included 3650 adults aged 50 years and older who completed questions in the 2020 Health and Retirement Study about social activity participation, including specific internet-based social activities such as emailing or accessing social networks. Cognitive functioning was measured using the standardized cognitive tasks assessing working memory, episodic memory, and attention and processing speed. The longitudinal analyses included the 2034 participants who also completed follow-up cognitive assessments in 2022. Results: Our results revealed that those with higher levels of internet-based social activity participation had higher levels of concurrent cognitive functioning than those with low levels of internet-based social activity participation, after adjusting for demographic and health-related factors and face-to-face social activity participation (b=0.44, SE 0.07; P<.001). More internet-based social activity participation also predicted better cognitive functioning 2 years later, even when adjusting for baseline cognitive functioning and other covariates (b=0.35, SE 0.09; P<.001). Conclusions: Our findings suggest that greater engagement in internet-based social activities is associated with higher levels of concurrent cognitive functioning and slower cognitive decline in middle-aged and older adults. %R 10.2196/63907 %U https://aging.jmir.org/2024/1/e63907 %U https://doi.org/10.2196/63907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60650 %T Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study %A Bosco,Cristina %A Shojaei,Fereshtehossadat %A Theisz,Alec Andrew %A Osorio Torres,John %A Cureton,Bianca %A Himes,Anna K %A Jessup,Nenette M %A Barnes,Priscilla A %A Lu,Yvonne %A Hendrie,Hugh C %A Hill,Carl V %A Shih,Patrick C %+ Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 (812) 856 5754, cribosco@iu.edu %K older African American and Black adults %K Alzheimer disease and related dementias %K health literacy %K Wizard of Oz %K voice assistant %K chatbot %K mobile app %K dementia %K geriatric %K aging %K Alzheimer disease %K artificial intelligence %K AI %K mHealth %K digital tools %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities—voice assistants, chatbots, and mobile apps—can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants’ cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user’s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community’s values and construct an interaction with the technology that is built on African American and Black communities’ needs and demands. %R 10.2196/60650 %U https://formative.jmir.org/2024/1/e60650 %U https://doi.org/10.2196/60650 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e65043 %T Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study %A Seidenfeld,Justine %A Tucker,Matthew %A Harris-Gersten,Melissa %A Fix,Gemmae M %A Guzman,Ivonne %A Sperber,Nina R %A Hastings,Susan N %+ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W Chapel Hill, Durham, NC, 27704, United States, 1 919 286 0411 ext 178386, justine.seidenfeld@va.gov %K ethnography %K direct observations %K emergency medicine %K dementia %K caregivers %D 2024 %7 6.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital—the “disposition” decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making. However, little is known about how these conversations are conducted and the real-world context in which they take place. Best practices in ED communication and shared decision-making for persons living with dementia and their care partners are limited. Objective: This study aims to characterize current practices in ED disposition conversations for persons living with dementia and their care partners, informed by perspectives from patient and care partner participants. Methods: This study will use an ethnographic design, including direct observation methods with a semistructured data collection tool to capture the ED encounter for up to 20 patient and care partner dyads, including all discussions about dispositions. Follow-up qualitative, semistructured interviews will be conducted with persons living with dementia and their care partners to explore specific observations made during their ED encounter, and to gain insight into their perspective on their role and elements of decision support used during that conversation. Results: Data collection was initiated in October 2023, with 13 dyads recruited and observed as of July 2024. This study is expected to be completed by December 2024. Conclusions: Novel methods can offer novel insights. By combining direct observation and follow-up interviews about an ED visit, our study design will provide insights into how ED disposition occurs in real-world settings for persons living with dementia. Findings can inform more patient-centered interventions for disposition decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/65043 %M 39642361 %R 10.2196/65043 %U https://www.researchprotocols.org/2024/1/e65043 %U https://doi.org/10.2196/65043 %U http://www.ncbi.nlm.nih.gov/pubmed/39642361 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56796 %T Exploring How Older Adults Experience semAPP, a 360° Media–Based Tool for Memory Assessment: Qualitative Study %A Bruni,Francesca %A Mancuso,Valentina %A Panigada,Jonathan %A Stramba-Badiale,Marco %A Cipresso,Pietro %A Pedroli,Elisa %+ Department of Theoretical and Applied Sciences, eCampus University, Via Isimbardi 10, Novedrate, 22060, Italy, 39 3460066231, v.mancuso95@gmail.com %K assessment %K virtual reality %K 360-degree videos %K user experience %K memory %K aging %K psycho gerontology %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users—whether they are patients, health care professionals, or both—in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360° media–based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47%) healthy individuals and 18 (53%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. %M 39637375 %R 10.2196/56796 %U https://aging.jmir.org/2024/1/e56796 %U https://doi.org/10.2196/56796 %U http://www.ncbi.nlm.nih.gov/pubmed/39637375 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e60050 %T Sentiment Dynamics Among Informal Caregivers in Web-Based Alzheimer Communities: Systematic Analysis of Emotional Support and Interaction Patterns %A Ni,Congning %A Song,Qingyuan %A Chen,Qingxia %A Song,Lijun %A Commiskey,Patricia %A Stratton,Lauren %A Malin,Bradley %A Yin,Zhijun %+ Department of Computer Science, Vanderbilt University, 2525 West End Avenue, Nashville, TN, 37203, United States, 1 6156381164, congning.ni@vanderbilt.edu %K informal caregivers %K Alzheimer disease %K dementias %K web-based community %K sentiment analysis %K topic modeling %K caregiving %K carers %K family care %K support group %K peer support %K gerontology %K geriatrics %K aging %K attitudes %K opinion %K perceptions %K perspectives %K sentiment %K cognitive %K web-based communities %K Linguistic Inquiry and Word Count %K machine learning %K Valence Aware Dictionary for Sentiment Reasoning %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (ADRD) are a growing global health challenge. ADRD place significant physical, emotional, and financial burdens on informal caregivers and negatively affects their well-being. Web-based social media platforms have emerged as valuable sources of peer support for these caregivers. However, there has been limited investigation into how web-based peer support might influence their mental well-being. Objective: This study aims to examine the dynamics of sentiment scores, a major indicator of mental well-being, among informal ADRD caregivers, specifically how their sentiment changes as they participate in caregiving experience discussions within 2 ADRD web-based communities. Methods: We collected data from 2 large web-based ADRD caregiving communities, ALZConnected (from November 2011 to August 2022) and TalkingPoint (from March 2003 to November 2022). Using the Valence Aware Dictionary for Sentiment Reasoning and Linguistic Inquiry and Word Count, we calculated sentiment scores for each post and evaluated how the initial sentiment score of a topic initiator evolves within a discussion thread. Structured topic modeling and regression analysis were used to identify the primary topics consistently associated with sentiment changes within these threads. We investigated longitudinal sentiment trends to identify patterns of sentimental stability or enhancement due to prolonged engagement in web-based communities by plotting linear interpolation lines of the sentiment values of each individual user. Results: The ALZConnected dataset comprised 532,992 posts, consisting of 57,641 topic threads and 475,351 comments. The TalkingPoint dataset was composed of 846,344 posts, consisting of 81,068 topic threads and 765,276 comments. Our research revealed that topic initiators experienced a notable increase in sentiment as they engaged in subsequent discussions within their threads, with a significant uptick in positivity in the short term. This phenomenon is part of a broader trend of steadily rising positive sentiment among ADRD caregivers. Using structured topic modeling, we cataloged a diverse range of topics that included both emotional aspects, such as family emotions, and practical concerns, such as diagnosis and treatment and everyday care practices. We observed that sentiment scores were positively aligned with discussions about family and daily routines life (coefficient=3.53; P<.001), while topics related to illness (coefficient=–1.37; P<.001) and caregiving facilities (coefficient=–1.98; P<.001) tended to correlate with lower sentiment scores. This evidence highlights the significant impact that both the time of participation and the posting content have on the sentiment changes of caregivers. Conclusions: This study identifies sentiment changes among informal ADRD caregivers through their interactions in 2 extensive web-based communities. These findings emphasize the importance of early emotional support within a topic thread and demonstrate a predominantly positive sentiment in these communities over time. These further highlight the value of web-based peer support and its potential to enhance the emotional well-being of informal ADRD caregivers. %M 39630495 %R 10.2196/60050 %U https://aging.jmir.org/2024/1/e60050 %U https://doi.org/10.2196/60050 %U http://www.ncbi.nlm.nih.gov/pubmed/39630495 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57320 %T In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review %A Chan,Andrew %A Cai,Joanne %A Qian,Linna %A Coutts,Brendan %A Phan,Steven %A Gregson,Geoff %A Lipsett,Michael %A Ríos Rincón,Adriana M %+ Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB, T5G 0H1, Canada, 1 7802037731, aychan1@ualberta.ca %K gerontology %K geriatrics %K older adult %K elderly %K aging %K aging-in-place %K localization %K ambient sensor %K wearable sensor %K acceptability %K home monitor %K health monitor %K technology %K digital health %K e-health %K telehealth %K clinical studies %K cognitive impairment %K neuro %K cognition %D 2024 %7 2.12.2024 %9 Review %J JMIR Aging %G English %X Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi–received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845 %R 10.2196/57320 %U https://aging.jmir.org/2024/1/e57320 %U https://doi.org/10.2196/57320 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57301 %T Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study %A Chen,Bowen %A Yang,Chun %A Ren,Shanshan %A Li,Penggao %A Zhao,Jin %+ Department of Hospital Epidemiology and Infection Control, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 571 86006435, enqizhao@zju.edu.cn %K aging %K cognitive function %K internet use %K longitudinal study %K fixed effects model %D 2024 %7 2.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults. %M 39539034 %R 10.2196/57301 %U https://www.jmir.org/2024/1/e57301 %U https://doi.org/10.2196/57301 %U http://www.ncbi.nlm.nih.gov/pubmed/39539034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56951 %T Evaluating the Impact of a Daylight-Simulating Luminaire on Mood, Agitation, Rest-Activity Patterns, and Social Well-Being Parameters in a Care Home for People With Dementia: Cohort Study %A Turley,Kate %A Rafferty,Joseph %A Bond,Raymond %A Mulvenna,Maurice %A Ryan,Assumpta %A Crawford,Lloyd %K digital health %K dementia %K dynamic lighting %K sensors %K circadian rhythm %K daylight %K wellbeing %K mood %K agitation %K sleep %K social wellbeing %K care home %K older adults %K elderly %K cardiac %K psychological %K monitoring %D 2024 %7 29.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective: This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods: An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results: Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect (P=.03), social isolation (P=.048), and feeling at home (P=.047) after 5‐10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity–related parameters of interdaily stability (P<.001), intradaily variation (P<.001), and relative amplitude (P=.03) from baseline to weeks 5‐10, with the effect propagating for interdaily stability at weeks 10‐16 as well (P<.001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions: Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters. %R 10.2196/56951 %U https://mhealth.jmir.org/2024/1/e56951 %U https://doi.org/10.2196/56951 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59684 %T The Digital Divide and Cognitive Disparities Among Older Adults: Community-Based Cohort Study in China %A Li,Yumeng %A Liu,Chen %A Sun,Jiaqing %A Zhang,Junying %A Li,Xin %A Zhang,Zhanjun %+ State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Xinjiekouwai Street No 19, Beijing, 100875, China, 86 010 58802882, lixin99@bnu.edu.cn %K digital divide %K internet use %K cognitive aging %K mild cognitive impairment %K socioeconomic status %K resource inequality %K cognitive disparities %K cognitive function %K elderly %K older adult %K aging %K community-based %K cohort study %K China %K ANCOVA %K mixed linear model %K Cox proportional hazards %K mental health %K internet %K digital health %K information and communication technologies %K ICT %K mHealth %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread adoption of information and communication technologies (ICTs) further deepens disparities in resource access, particularly among the aging population. However, the relationship between these factors and their resulting impact on cognitive abilities remains uncertain. Objective: This study aims to investigate the potential impact of the digital divide on individuals’ cognitive function and its association with the development and reversion of mild cognitive impairment (MCI). Methods: This cohort study used data from Beijing Aging Brain Rejuvenation (BABRI) study applying a multistage cluster sampling design between 2008 and 2020. The digital divide was quantified by the frequency of using ICTs. Analysis of covariance (ANCOVA), mixed linear models, and Cox proportional hazards models were used to model the association of digital divide and multidomain cognition. Results: Among the 10098 participants, nearly half (n=4941, 48.9%) faced the digital divide, which was associated with a worse performance in processing speed (F10096=10.67; P<.001; effect size r=0.42), rather than memory, executive function, and language. The model indicated that individuals’ physical and mental health, combined with their educational and occupational prestige, influenced the resources they attained, which ultimately caused the digital divide. Moreover, longitudinal data revealed that older adults who successfully crossed the digital divide during the tracking process and those who had already done so prior to tracking showed significantly slower rates of decline in processing speed (B=–1.98, P<.05; B=–2.62, P<.01) and general cognitive function (B=3.50, P<.001; B=3.13, P<.01). Additionally, overcoming the digital divide was also associated with a lower risk of developing MCI (hazard ratio [HR] 0.5, 95% CI 0.34-0.74; HR 0.43, 95% CI 0.29-0.62) and a greater probability of reversion from MCI to normal cognition (HR 6, 95% CI 3.77-9.56; HR 9.22, 95% CI 5.63-15.11). Conclusions: Overcoming the digital divide was significantly associated with improved cognitive function, a slower aging rate in cognitive performance, a reduced risk of developing MCI, and a higher likelihood of reverting from MCI to normal cognition. %M 39602795 %R 10.2196/59684 %U https://www.jmir.org/2024/1/e59684 %U https://doi.org/10.2196/59684 %U http://www.ncbi.nlm.nih.gov/pubmed/39602795 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51978 %T Characterizing Performance on a Suite of English-Language NeuroUX Mobile Cognitive Tests in a US Adult Sample: Ecological Momentary Cognitive Testing Study %A Paolillo,Emily W %A Bomyea,Jessica %A Depp,Colin A %A Henneghan,Ashley M %A Raj,Anunay %A Moore,Raeanne C %+ Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, 92093, United States, 1 619 543 5378, r6moore@health.ucsd.edu %K digital health %K cognition %K cognitive aging %K neuropsychology %K mobile health %K psychometrics %K mobile phone %K Ecological Momentary Assessment %K EMA %K NeuroUX %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples. Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan. Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone). Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age—but not other demographics—was associated with finding the tests more challenging. Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research. %M 39586088 %R 10.2196/51978 %U https://www.jmir.org/2024/1/e51978 %U https://doi.org/10.2196/51978 %U http://www.ncbi.nlm.nih.gov/pubmed/39586088 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60574 %T Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey %A Charles,Lesley %A Tang,Eileen %A Tian,Peter George Jaminal %A Chan,Karenn %A Brémault-Phillips,Suzette %A Dobbs,Bonnie %A Vokey,Camelia %A Polard,Sharna %A Parmar,Jasneet %+ Division of Care of the Elderly, Department of Family Medicine, University of Alberta, 5-10 University Terrace, University of Alberta 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada, 1 780 735 8882, LCharles@ualberta.ca %K decision making capacity %K mental competency %K aged %K mobile applications %K mobile phone %K Canada %K covid-19 %K pandemics %K dementia %K survey %K virtual capacity assessment %K characteristics %K barriers %K facilitators %K virtual decision making %K assessment %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients’ characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client’s and assessor’s sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors’ ability to perform DMCA’s virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. %M 39585735 %R 10.2196/60574 %U https://formative.jmir.org/2024/1/e60574 %U https://doi.org/10.2196/60574 %U http://www.ncbi.nlm.nih.gov/pubmed/39585735 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59974 %T Mobility-Based Smartphone Digital Phenotypes for Unobtrusively Capturing Everyday Cognition, Mood, and Community Life-Space in Older Adults: Feasibility, Acceptability, and Preliminary Validity Study %A Hackett,Katherine %A Xu,Shiyun %A McKniff,Moira %A Paglia,Lido %A Barnett,Ian %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 484 843 1321, tania.giovannetti@temple.edu %K digital phenotyping %K digital biomarkers %K monitoring %K mHealth %K cognition %K mobility %K life space %K depression %K location data %K Alzheimer disease %K aging %K mobile phone %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. Objective: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. Methods: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. Results: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants’ scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r≥0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. Conclusions: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults’ personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples. %M 39576984 %R 10.2196/59974 %U https://humanfactors.jmir.org/2024/1/e59974 %U https://doi.org/10.2196/59974 %U http://www.ncbi.nlm.nih.gov/pubmed/39576984 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e59396 %T A Multivariable Prediction Model for Mild Cognitive Impairment and Dementia: Algorithm Development and Validation %A Oh,Sarah Soyeon %A Kang,Bada %A Hong,Dahye %A Kim,Jennifer Ivy %A Jeong,Hyewon %A Song,Jinyeop %A Jeon,Minkyu %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 22283283, bdkang@yuhs.ac %K mild cognitive impairment %K machine learning algorithms %K sociodemographic factors %K gerontology %K geriatrics %K older people %K aging %K MCI %K dementia %K Alzheimer %K cognitive %K machine learning %K prediction %K algorithm %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Mild cognitive impairment (MCI) poses significant challenges in early diagnosis and timely intervention. Underdiagnosis, coupled with the economic and social burden of dementia, necessitates more precise detection methods. Machine learning (ML) algorithms show promise in managing complex data for MCI and dementia prediction. Objective: This study assessed the predictive accuracy of ML models in identifying the onset of MCI and dementia using the Korean Longitudinal Study of Aging (KLoSA) dataset. Methods: This study used data from the KLoSA, a comprehensive biennial survey that tracks the demographic, health, and socioeconomic aspects of middle-aged and older Korean adults from 2018 to 2020. Among the 6171 initial households, 4975 eligible older adult participants aged 60 years or older were selected after excluding individuals based on age and missing data. The identification of MCI and dementia relied on self-reported diagnoses, with sociodemographic and health-related variables serving as key covariates. The dataset was categorized into training and test sets to predict MCI and dementia by using multiple models, including logistic regression, light gradient-boosting machine, XGBoost (extreme gradient boosting), CatBoost, random forest, gradient boosting, AdaBoost, support vector classifier, and k-nearest neighbors, and the training and test sets were used to evaluate predictive performance. The performance was assessed using the area under the receiver operating characteristic curve (AUC). Class imbalances were addressed via weights. Shapley additive explanation values were used to determine the contribution of each feature to the prediction rate. Results: Among the 4975 participants, the best model for predicting MCI onset was random forest, with a median AUC of 0.6729 (IQR 0.3883-0.8152), followed by k-nearest neighbors with a median AUC of 0.5576 (IQR 0.4555-0.6761) and support vector classifier with a median AUC of 0.5067 (IQR 0.3755-0.6389). For dementia onset prediction, the best model was XGBoost, achieving a median AUC of 0.8185 (IQR 0.8085-0.8285), closely followed by light gradient-boosting machine with a median AUC of 0.8069 (IQR 0.7969-0.8169) and AdaBoost with a median AUC of 0.8007 (IQR 0.7907-0.8107). The Shapley values highlighted pain in everyday life, being widowed, living alone, exercising, and living with a partner as the strongest predictors of MCI. For dementia, the most predictive features were other contributing factors, education at the high school level, education at the middle school level, exercising, and monthly social engagement. Conclusions: ML algorithms, especially XGBoost, exhibited the potential for predicting MCI onset using KLoSA data. However, no model has demonstrated robust accuracy in predicting MCI and dementia. Sociodemographic and health-related factors are crucial for initiating cognitive conditions, emphasizing the need for multifaceted predictive models for early identification and intervention. These findings underscore the potential and limitations of ML in predicting cognitive impairment in community-dwelling older adults. %M 39576972 %R 10.2196/59396 %U https://medinform.jmir.org/2024/1/e59396 %U https://doi.org/10.2196/59396 %U http://www.ncbi.nlm.nih.gov/pubmed/39576972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64149 %T A Mindfulness-Based Lifestyle Intervention for Dementia Risk Reduction: Protocol for the My Healthy Brain Feasibility Randomized Controlled Trial %A Mace,Ryan A %A Law,Makenna E %A Cohen,Joshua E %A Ritchie,Christine S %A Okereke,Olivia I %A Hoeppner,Bettina B %A Brewer,Judson A %A Bartels,Stephen J %A Vranceanu,Ana-Maria %A , %+ Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, United States, 1 617 724 7030, RMACE@mgh.harvard.edu %K lifestyle %K cognitive decline %K brain health %K mindfulness %K mind-body therapies %K telemedicine %K digital health %K randomized clinical trial %D 2024 %7 21.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lifestyle behavior change and mindfulness have direct and synergistic effects on cognitive functioning and may prevent Alzheimer disease and Alzheimer disease–related dementias (AD/ADRD). We are iteratively developing and testing My Healthy Brain (MHB), the first mindfulness-based lifestyle group program targeting AD/ADRD risk factors in older adults with subjective cognitive decline. Our pilot studies (National Institutes of Health [NIH] stage 1A) have shown that MHB is feasible, acceptable, and associated with improvement in lifestyle behavior and cognitive outcomes. Objective: We will compare the feasibility of MHB versus an education control (health enhancement program [HEP]) in 50 older adults (aged ≥60 y) with subjective cognitive decline and AD/ADRD risk factors. In an NIH stage 1B randomized controlled trial (RCT), we will evaluate feasibility benchmarks, improvements in cognitive and lifestyle outcomes, and engagement of hypothesized mechanisms. Methods: We are recruiting through clinics, flyers, web-based research platforms, and community partnerships. Participants are randomized to MHB or the HEP, both delivered in telehealth groups over 8 weeks. MHB participants learn behavior modification and mindfulness skills to achieve individualized lifestyle goals. HEP participants receive lifestyle education and group support. Assessments are repeated after the intervention and at a 6-month follow-up. Our primary outcomes are feasibility, acceptability, appropriateness, credibility, satisfaction, and fidelity benchmarks. The secondary outcomes are cognitive function and lifestyle (physical activity, sleep, nutrition, alcohol and tobacco use, and mental and social activity) behaviors. Data analyses will include the proportion of MHB and HEP participants who meet each benchmark (primary outcome) and paired samples 2-tailed t tests, Cohen d effect sizes, and the minimal clinically important difference for each measure (secondary outcomes). Results: Recruitment began in January 2024. We received 225 inquiries. Of these 225 individuals, 40 (17.8%) were eligible. Of the 40 eligible participants, 21 (52.5%) were enrolled in 2 group cohorts, 17 (42.5%) were on hold for future group cohorts, and 2 (5%) withdrew before enrollment. All participants have completed before the intervention assessments. All cohort 1 participants (9/21, 43%) have completed either MHB or the HEP (≥6 of 8 sessions) and after the intervention assessments. The intervention for cohort 2 (12/21, 57%) is ongoing. Adherence rates for the Garmin Vivosmart 5 (128/147, 87.1% weeks) and daily surveys (105/122, 86.1% weeks) are high. No enrolled participants have dropped out. Enrollment is projected to be completed by December 2024. Conclusions: The RCT will inform the development of a larger efficacy RCT (NIH stage 2) of MHB versus the HEP in a more diverse sample of older adults, testing mechanisms of improvements through theoretically driven mediators and moderators. The integration of mindfulness with lifestyle behavior change in MHB has the potential to be an effective and sustainable approach for increasing the uptake of AD/ADRD risk reduction strategies among older adults. Trial Registration: ClinicalTrials.gov NCT05934136; https://www.clinicaltrials.gov/study/NCT05934136 International Registered Report Identifier (IRRID): DERR1-10.2196/64149 %M 39571150 %R 10.2196/64149 %U https://www.researchprotocols.org/2024/1/e64149 %U https://doi.org/10.2196/64149 %U http://www.ncbi.nlm.nih.gov/pubmed/39571150 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58517 %T mHealth Apps for Dementia Caregivers: Systematic Examination of Mobile Apps %A Zou,Ning %A Xie,Bo %A He,Daqing %A Hilsabeck,Robin %A Aguirre,Alyssa %K dementia %K informal care %K mobile health applications %K tailoring %K information quality %K mobile phone %D 2024 %7 20.11.2024 %9 %J JMIR Aging %G English %X Background: Informal caregivers of persons living with dementia are increasingly using mobile health (mHealth) apps to obtain care information. mHealth apps are seen as promising tools to better support caregivers’ complex and evolving information needs. Yet, little is known about the types and quality of dementia care information that these apps provide. Is this information for caregivers individually tailored; if so, how? Objective: We aim to address the aforementioned gaps in the literature by systematically examining the types and quality of care-related information provided in publicly available apps for caregivers of persons living with dementia as well as app features used to tailor information to caregivers’ information wants and situations. Methods: In September 2023, we used a multistage process to select mobile apps for caregivers of persons living with dementia. The final sample included 35 apps. We assessed (1) types of dementia care information provided in the apps, using our 3-item Alzheimer disease and related dementias daily care strategy framework, which encompasses educational information, tangible actions, and referral information; (2) quality of apps’ care information, using the 11 indicators recommended by the National Library of Medicine; and (3) types of tailoring to provide personalization, feedback, and content matching, which are common tailoring strategies described in the literature. Results: Educational information was the most prevalent type of information provided (29/35 apps, 83%), followed by information about tangible actions (18/35, 51%) and referrals (14/35, 40%). All apps presented their objectives clearly and avoided unrealistic or emotional claims. However, few provided information to explain whether the app’s content was generated or reviewed by experts (7/35, 20%) or how its content was selected (4/35, 11%). Further, 6 of the 35 (17%) apps implemented 1 type of tailoring; of them, 4 (11%) used content matching and the other 2 (6%) used personalization. No app used 2 types of tailoring; only 2 (6%) used all 3 types (the third is feedback). Conclusions: Existing dementia care apps do not provide sufficient high-quality, tailored information for informal caregivers. Caregivers should exercise caution when they use dementia care apps for informational support. Future research should focus on designing dementia care apps that incorporate quality-assured, transparency-enhanced, evidence-based artificial intelligence–enabled mHealth solutions for caregivers. %R 10.2196/58517 %U https://aging.jmir.org/2024/1/e58517 %U https://doi.org/10.2196/58517 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e64248 %T Patient Profile and Cost Savings of Long-Term Care in a Spanish Hospital: Retrospective Observational Study %A Mira,José Joaquín %A García-Torres,Daniel %A Bonell-Guerrero,María del Mar %A Cáceres-Sevilla,Ana Isabel %A Ramirez-Sanz,Martina %A Martínez-Lleo,Rosa %A Carratalá,Concepción %+ Health Psychology Department, Universidad Miguel Hernández, Universidad Avenue, Elche, 03202, Spain, 34 966658984, jose.mira@umh.es %K chronicity %K length of stay %K hospital %K chronic %K long-term care %K demographics %K gerontology %K Hospitals for Acute and Chronic Long-Term Extended Stay %K HACLES %K healthcare economics %K cost savings %D 2024 %7 19.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases. Objective: This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers. Methods: A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Consellería Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed. Results: Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61%). The mortality rate (odds ratio [OR] 61.8, 95% CI 53.2-70.5) was similar between men and women (OR 54.1, 95% CI 47.8-71.5 vs OR 59.7, 95% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US $42,614,846 per 1000 admissions. Conclusions: Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system. %M 39561362 %R 10.2196/64248 %U https://www.i-jmr.org/2024/1/e64248 %U https://doi.org/10.2196/64248 %U http://www.ncbi.nlm.nih.gov/pubmed/39561362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59572 %T Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis %A Zhou,Wu %A Feng,HaiXia %A Tao,Hua %A Sun,Hui %A Zhang,TianTian %A Wang,QingXia %A Zhang,Li %+ School of Medicine, Southeast University, 87 Dingjiaqiao, Gulou District, Jiangsu Province, Nanjing, 210009, China, 86 02583272077, xrzfhx@163.com %K stroke %K cognitive dysfunction %K analysis of associated factors %K MMSE %K Mini-Mental State Examination %K status survey %K cognitive %K survey %K cognitive impairment %K cross-sectional study %K cross sectional %K stroke patients %K cognition %K education %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes. Objective: This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes. Methods: A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores. Results: Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=–0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills. Conclusions: This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study’s reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke. %M 39560985 %R 10.2196/59572 %U https://formative.jmir.org/2024/1/e59572 %U https://doi.org/10.2196/59572 %U http://www.ncbi.nlm.nih.gov/pubmed/39560985 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58190 %T Exploring the Experiences of Times Without Care and Encounters in Persons With Dementia in the Swiss and German Nursing Home and Domiciliary Care Settings: Protocol for an Ethnographic Multimethods Study %A Beer,Thomas %A Hirt,Julian %A Adlbrecht,Laura %A Lindwedel,Ulrike %A Dammert,Matthias %A Maurer,Carola %A Kliegel,Matthias %A König,Peter %A Bleses,Helma M %+ Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St.Gallen, 9000, Switzerland, 41 58 257 15 18, thomas.beer@ost.ch %K dementia %K nursing homes %K home nursing %K home care services %K nursing %K ethnography %K formal caregivers %K informal caregivers %D 2024 %7 18.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persons with dementia spend a large part of the day without care and encounters, often without activity, as confirmed by numerous studies. However, no scientific analysis has examined how persons with dementia experience these periods. Such knowledge would be highly relevant for health care professionals and relatives to develop adequate strategies for dealing with times without care. Objective: We aim to reconstruct times without care and encounters in persons with dementia in the nursing home and domiciliary care settings and develop a typology. This typology will address the lifeworld understandings of time and the ways of arranging the time of persons with dementia. Methods: Our study is designed as an explorative, sequential multimethods investigation. We aim to systematically reconstruct times without care and encounters over a period of 36 months using ethnographic methods. Afterward, we will examine the resulting typology using a survey. To describe different social and caring cultures, practices, and arrangements, we will analyze time periods across all phases of dementia in (1) institutions exclusively caring for persons with dementia, (2) institutions where persons with dementia and those without live together, and (3) domiciliary care. For each type of care, our target is 10 intensive case observations. These observations will occur in both participatory and nonparticipatory ways. We video record selected situations and conduct situational conversations and interviews with persons with dementia and nurses. We are aiming for a minimum sample of 30 persons with dementia plus their caregivers (ie, relatives of people with dementia and professional caregivers). We will analyze data according to grounded theory methodology. Furthermore, we will perform a hermeneutic sequence analysis of selected text passages. To interpret the video material, we will conduct a video interaction analysis. To obtain complementary information about the newly developed typology, we will survey approximately 400 formal and 150 informal caregivers. We will summarize the ethnography and survey findings into an overall concept of times without care and encounters in persons with dementia. To fulfill the research objectives, our cross-disciplinary and cross-country team comprises researchers with expertise in nursing sciences, gerontology, sociology, psychology, and ethnography. Results: Our approach allows formulating statements about the nature, frequency, and prevalence of times without care and encounters in people with dementia across countries and types of care. Thus, we will contribute to making visible the lifeworld of persons with dementia. Our study commenced in March 2022 and will conclude in May 2025. The results are expected to be published in the fall of 2025. Conclusions: Our research offers points of departure for the representative investigation of times without care and encounters in persons with dementia, for the development of diagnostic instruments, and for dealing critically with possibilities of interruption (eg, by developing targeted interventions). International Registered Report Identifier (IRRID): DERR1-10.2196/58190 %M 39556815 %R 10.2196/58190 %U https://www.researchprotocols.org/2024/1/e58190 %U https://doi.org/10.2196/58190 %U http://www.ncbi.nlm.nih.gov/pubmed/39556815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60453 %T Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study %A Ding,Huitong %A Gifford,Katherine %A Shih,Ludy C %A Ho,Kristi %A Rahman,Salman %A Igwe,Akwaugo %A Low,Spencer %A Popp,Zachary %A Searls,Edward %A Li,Zexu %A Madan,Sanskruti %A Burk,Alexa %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Au,Rhoda %A Lin,Honghuang %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K digital brain health %K older adults %K perspectives %K semistructured interviews %K natural language processing %K mobile phone %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated. Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing. Methods: The study included 28 participants from the Boston University Alzheimer’s Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants’ experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform. Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with “like,” “well,” and “good” being the most frequently mentioned positive terms. However, terms such as “problem” and “hard” indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from –1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort. Conclusions: The study highlights the importance of understanding older adults’ attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health. %M 39556805 %R 10.2196/60453 %U https://formative.jmir.org/2024/1/e60453 %U https://doi.org/10.2196/60453 %U http://www.ncbi.nlm.nih.gov/pubmed/39556805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56636 %T Digital Exclusion and Cognitive Function in Elderly Populations in Developing Countries: Insights Derived From 2 Longitudinal Cohort Studies %A Duan,Sainan %A Chen,Dongxu %A Wang,Jinping %A Paramboor,Mohammed Sharooq %A Xia,Zhen %A Xu,Wanting %A Han,Kun %A Zhu,Tao %A Jiang,Xiaoqin %+ Department of Anesthesiology, West China Second University Hospital, Sichuan University, No 20, Section 3, South Renmin Road, Chengdu, 610041, China, 86 18180609218, 1598862657jxq@scu.edu.cn %K digital exclusion %K cognition %K cohort study %K developing country %K China Health and Retirement Longitudinal Study %K CHARLS %K %K MHAS %K cognitive decline %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognition disorders not only lead to adverse health consequences but also contribute to a range of socioeconomic challenges and diminished capacity for performing routine daily activities. In the digital era, understanding the impact of digital exclusion on cognitive function is crucial, especially in developing countries. Objective: This study aimed to evaluate the association between digital exclusion and cognitive function among elderly populations in developing countries. Methods: Using data from CHARLS (China Health and Retirement Longitudinal Study) from 2011 to 2020 and MHAS (Mexican Health & Aging Study) from 2012 to 2021, we defined digital exclusion as self-reported absence from the internet. Cognitive function was assessed through 5 tests: orientation, immediate verbal recall, delayed verbal recall, serial 7s, and figure recall. Cognitive function was assessed in 2 categories: worse cognition (a categorical variable that classifies cognition as either better or worse compared to the entire cohort population) and cognitive scores (a continuous variable representing raw cognitive scores across multiple follow-up waves). Logistic regression analyses and generalized estimating equation (GEE) analyses were used to examine the relationship between cognitive function and digital exclusion, adjusting for potential confounders, including demographics, lifestyle factors, history of chronic diseases, basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and basic cognitive abilities. Results: After excluding participants with probable cognitive impairment at baseline and those who did not have a complete cognitive assessment in any given year (ie, all tests in the cognitive assessment must be completed in any follow-up wave), a total of 24,065 participants in CHARLS (n=11,505, 47.81%) and MHAS (n=12,560, 52.19%) were included. Of these, 96.78% (n=11,135) participants in CHARLS and 70.02% (n=8795) in MHAS experienced digital exclusion. Adjusted logistic regression analyses revealed that individuals with digital exclusion were more likely to exhibit worse cognitive performance in both CHARLS (odds ratio [OR] 2.04, 95% CI 1.42-2.99; P<.001) and MHAS (OR 1.40, 95% CI 1.26-1.55; P<.001). Gender and age did not significantly modify the relationship between digital exclusion and worse cognition (intervention P>.05). The fully adjusted mean differences in global cognitive scores between the 2 groups were 0.98 (95% CI 0.70-1.28; P<.001) in CHARLS and 0.50 (95% CI 0.40-0.59; P<.001) in MHAS. Conclusions: A substantial proportion of older adults, particularly in China, remain excluded from internet access. Our study examined longitudinal changes in cognitive scores and performed cross-sectional comparisons using Z-score standardization. The findings suggest that digital exclusion is linked to an increased risk of cognitive decline among older adults in developing countries. Promoting internet access may help mitigate this risk and support better cognitive health in these populations. %M 39546790 %R 10.2196/56636 %U https://www.jmir.org/2024/1/e56636 %U https://doi.org/10.2196/56636 %U http://www.ncbi.nlm.nih.gov/pubmed/39546790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58537 %T Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults %A Dumassais,Shirley %A Grewal,Karl Singh %A Aubin,Gabrielle %A O'Connell,Megan %A Phillips,Natalie A %A Wittich,Walter %+ École d'Optométrie, Université de Montréal, 3744 Jean Brillant Street, Montréal, QC, H3T 1P1, Canada, 1 514 343 6471, shirley.dumassais@umontreal.ca %K neuropsychological tests %K telemedicine %K social inclusion %K telehealth %K remote %K qualitative %K neuropsychological %K cognitive %K screening %K assessment %K perception %K perspective %K telephone %K cross-sectional %K thematic %K mobile phone %K Montreal Cognitive Assessment %K MoCA %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. %M 39546346 %R 10.2196/58537 %U https://formative.jmir.org/2024/1/e58537 %U https://doi.org/10.2196/58537 %U http://www.ncbi.nlm.nih.gov/pubmed/39546346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54335 %T Early Identification of Cognitive Impairment in Community Environments Through Modeling Subtle Inconsistencies in Questionnaire Responses: Machine Learning Model Development and Validation %A Gao,Hongxin %A Schneider,Stefan %A Hernandez,Raymond %A Harris,Jenny %A Maupin,Danny %A Junghaenel,Doerte U %A Kapteyn,Arie %A Stone,Arthur %A Zelinski,Elizabeth %A Meijer,Erik %A Lee,Pey-Jiuan %A Orriens,Bart %A Jin,Haomiao %+ School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 7438534086, h.jin@surrey.ac.uk %K machine learning %K artificial intelligence %K cognitive impairments %K surveys and questionnaires %K community health services %K public health %K early identification %K elder care %K dementia %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The underdiagnosis of cognitive impairment hinders timely intervention of dementia. Health professionals working in the community play a critical role in the early detection of cognitive impairment, yet still face several challenges such as a lack of suitable tools, necessary training, and potential stigmatization. Objective: This study explored a novel application integrating psychometric methods with data science techniques to model subtle inconsistencies in questionnaire response data for early identification of cognitive impairment in community environments. Methods: This study analyzed questionnaire response data from participants aged 50 years and older in the Health and Retirement Study (waves 8-9, n=12,942). Predictors included low-quality response indices generated using the graded response model from four brief questionnaires (optimism, hopelessness, purpose in life, and life satisfaction) assessing aspects of overall well-being, a focus of health professionals in communities. The primary and supplemental predicted outcomes were current cognitive impairment derived from a validated criterion and dementia or mortality in the next ten years. Seven predictive models were trained, and the performance of these models was evaluated and compared. Results: The multilayer perceptron exhibited the best performance in predicting current cognitive impairment. In the selected four questionnaires, the area under curve values for identifying current cognitive impairment ranged from 0.63 to 0.66 and was improved to 0.71 to 0.74 when combining the low-quality response indices with age and gender for prediction. We set the threshold for assessing cognitive impairment risk in the tool based on the ratio of underdiagnosis costs to overdiagnosis costs, and a ratio of 4 was used as the default choice. Furthermore, the tool outperformed the efficiency of age or health-based screening strategies for identifying individuals at high risk for cognitive impairment, particularly in the 50- to 59-year and 60- to 69-year age groups. The tool is available on a portal website for the public to access freely. Conclusions: We developed a novel prediction tool that integrates psychometric methods with data science to facilitate “passive or backend” cognitive impairment assessments in community settings, aiming to promote early cognitive impairment detection. This tool simplifies the cognitive impairment assessment process, making it more adaptable and reducing burdens. Our approach also presents a new perspective for using questionnaire data: leveraging, rather than dismissing, low-quality data. %M 39536306 %R 10.2196/54335 %U https://formative.jmir.org/2024/1/e54335 %U https://doi.org/10.2196/54335 %U http://www.ncbi.nlm.nih.gov/pubmed/39536306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53348 %T The Effects of Virtual Reality–Based Reminiscence Therapies for Older Adults With Cognitive Impairment: Systematic Review %A Mao,Qian %A Zhao,Zhen %A Yu,Lisha %A Zhao,Yang %A Wang,Hailiang %+ School of Design, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, 999077, China, 852 27665471, hailiang.wang@polyu.edu.hk %K virtual reality %K reminiscence therapy %K cognitive impairment %K older adults %K mobile phone %D 2024 %7 12.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Reminiscence therapy (RT) is a commonly used nonpharmaceutical treatment for cognitive impairment. Artifacts or conversations are used in RT to recall individuals’ memories and past experiences. Virtual reality (VR) has increasingly been used as an assistive technology during RT. However, the effects of VR-based RT (VR-RT) methods remain unclear, and insights into the related benefits and challenges are urgently needed. Objective: The study aims to systematically review the effects of VR-RTs for older adults with cognitive impairment. Methods: Seven databases (MEDLINE, Academic Search Premier, CINAHL, Web of Science, PubMed, the Cochrane Central Register of Controlled Trials, and ScienceDirect) were searched to identify relevant articles published from inception to August 10, 2023. Peer-reviewed publications that assessed the effect of VR-RTs (ie, using virtual clues to evoke participants’ memories or past experiences) on cognitive-related outcomes were included. Two independent researchers conducted the literature search, review, and data extraction processes. A narrative synthesis approach was used to analyze the extracted data. Results: Of the 537 identified articles, 22 were ultimately included in the data analysis. The results revealed that VR-RTs could maintain cognitive status (4/4, 100%) and reduce anxiety (2/2, 100%) in older adults with cognitive impairment. Nevertheless, one study found a cognitive improvement after VR-RTs, whereas cognitive degradation was observed at a 3- to 6-month follow-up measure. Around 88% (7/8) of the included studies indicated that VR-RTs improved memory; however, the evidence regarding the beneficial effects of VR-RTs was limited in improving quality of life (1/4, 25%) and reducing apathy (0/2, 0%) and depression (1/3, 33%). The results indicated that VR-RTs are safe, engaging, acceptable, and satisfying for older adults with cognitive impairment. In VR scenarios, personalized stimulus materials related to the users’ youth experiences were more effective for treating cognitive impairment than other stimulus materials. Conclusions: The results of this systematic review demonstrate the potential benefits of VR-RT for older adults with cognitive impairment, especially in improving emotion and memory and maintaining cognitive status. VR-RT is also safe and enjoyable for older adults. However, due to the trial heterogeneity of included studies, we can only provide qualitative results instead of performing meta-analysis to quantify the effect size of VR-RTs. Thus, more randomized controlled trials are required to examine the designs and effects of VR-RTs for groups of older adults with specific needs. %M 39531267 %R 10.2196/53348 %U https://www.jmir.org/2024/1/e53348 %U https://doi.org/10.2196/53348 %U http://www.ncbi.nlm.nih.gov/pubmed/39531267 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53447 %T Using a Device-Free Wi-Fi Sensing System to Assess Daily Activities and Mobility in Low-Income Older Adults: Protocol for a Feasibility Study %A Chung,Jane %A Pretzer-Aboff,Ingrid %A Parsons,Pamela %A Falls,Katherine %A Bulut,Eyuphan %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047277980, jane.chung@emory.edu %K Wi-Fi sensing %K dementia %K mild cognitive impairment %K older adults %K health disparities %K in-home activities %K mobility %K machine learning %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults belonging to racial or ethnic minorities with low socioeconomic status are at an elevated risk of developing dementia, but resources for assessing functional decline and detecting cognitive impairment are limited. Cognitive impairment affects the ability to perform daily activities and mobility behaviors. Traditional assessment methods have drawbacks, so smart home technologies (SmHT) have emerged to offer objective, high-frequency, and remote monitoring. However, these technologies usually rely on motion sensors that cannot identify specific activity types. This group often lacks access to these technologies due to limited resources and technology experience. There is a need to develop new sensing technology that is discreet, affordable, and requires minimal user engagement to characterize and quantify various in-home activities. Furthermore, it is essential to explore the feasibility of developing machine learning (ML) algorithms for SmHT through collaborations between clinical researchers and engineers and involving minority, low-income older adults for novel sensor development. Objective: This study aims to examine the feasibility of developing a novel channel state information–based device-free, low-cost Wi-Fi sensing system, and associated ML algorithms for localizing and recognizing different patterns of in-home activities and mobility in residents of low-income senior housing with and without mild cognitive impairment. Methods: This feasibility study was conducted in collaboration with a wellness care group, which serves the healthy aging needs of low-income housing residents. Prior to this feasibility study, we conducted a pilot study to collect channel state information data from several activity scenarios (eg, sitting, walking, and preparing meals) using the proposed Wi-Fi sensing system continuously over a week in apartments of low-income housing residents. These activities were videotaped to generate ground truth annotations to test the accuracy of the ML algorithms derived from the proposed system. Using qualitative individual interviews, we explored the acceptability of the Wi-Fi sensing system and implementation barriers in the low-income housing setting. We use the same study protocol for the proposed feasibility study. Results: The Wi-Fi sensing system deployment began in November 2022, with participant recruitment starting in July 2023. Preliminary results will be available in the summer of 2025. Preliminary results are focused on the feasibility of developing ML models for Wi-Fi sensing–based activity and mobility assessment, community-based recruitment and data collection, ground truth, and older adults’ Wi-Fi sensing technology acceptance. Conclusions: This feasibility study can make a contribution to SmHT science and ML capabilities for early detection of cognitive decline among socially vulnerable older adults. Currently, sensing devices are not readily available to this population due to cost and information barriers. Our sensing device has the potential to identify individuals at risk for cognitive decline by assessing their level of physical function by tracking their in-home activities and mobility behaviors, at a low cost. International Registered Report Identifier (IRRID): DERR1-10.2196/53447 %M 39531268 %R 10.2196/53447 %U https://www.researchprotocols.org/2024/1/e53447 %U https://doi.org/10.2196/53447 %U http://www.ncbi.nlm.nih.gov/pubmed/39531268 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57036 %T Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews %A Desai,Chaitali %A Dove,Erica %A Nanthakumar,Jarshini %A Main,Emilia %A Colquhoun,Heather %A Astell,Arlene %A Mihailidis,Alex %A Layton,Natasha %A Burhan,Amer M %A Chan,Brian %A Wang,Rosalie H %+ Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON, M5G 1V7, Canada, 1 416 946 8573, chaitali.desai@mail.utoronto.ca %K assistive technology %K assistive products %K dementia %K care partners %K caregivers %K elderly %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Canada, more than 60% of persons living with dementia reside in their own homes, and over 25% rely heavily on their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, and walking. Assistive technology (AT) is a key dementia management strategy, helping to maintain health and social support in home and community settings. AT comprises assistive products and services required for safe and effective use. Persons living with dementia and their care partners often require multiple types of AT to maintain their needs, dignity, and autonomy. AT for dementia management is rapidly developing with abundant scientific literature, which can present a challenge to efficiently navigate and extract insights for policy and personal decision-making. Objective: This scoping review aims to synthesize review-level evidence from published scientific literature on AT to support dementia management for persons living with dementia and their care partners in their homes and communities. Research gaps in knowledge and areas for further investigation into the use and access of AT will be identified. This review will provide an overview of AT types and characteristics and chart the outcomes and conclusions in review-level evidence. Methods: This review will follow the Joanna Briggs Institute’s framework for conducting scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 6 electronic databases will be searched. Articles will be screened according to the “Population-Concept-Context (PCC)” framework for eligible studies. Population includes persons living with dementia, their care partners, and health care professionals (eg, therapists or others who recommend AT). Concept includes AT and self-help devices of many types. Context includes homes and communities. A data charting template will guide data extraction, charting, and summarization. A descriptive numerical summary and an overview of the findings will be presented. Data, such as (1) article information (eg, author and year), (2) article characteristics (eg, review type), (3) AT types and characteristics, (4) setting and population characteristics, and (5) key review outcomes and conclusions, will be extracted. Results: A total of 10,978 unique citations were identified across the 6 electronic databases. This review is in the full-text screening stage, which is expected to be completed by October 2024. Conclusions: This review will provide a comprehensive understanding and documentation of the published scientific literature on AT to support dementia management. Findings from this review are expected to provide evidence-based insights on the complexities of AT types, uses, availability, and access. The author group’s diverse national and international perspectives may contribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons living with dementia. Trial Registration: Open Science Framework DKSM9; https://osf.io/dksm9 International Registered Report Identifier (IRRID): PRR1-10.2196/57036 %M 39527790 %R 10.2196/57036 %U https://www.researchprotocols.org/2024/1/e57036 %U https://doi.org/10.2196/57036 %U http://www.ncbi.nlm.nih.gov/pubmed/39527790 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e59556 %T Twenty-Five Years of AI in Neurology: The Journey of Predictive Medicine and Biological Breakthroughs %A Gutman,Barak %A Shmilovitch,Amit-Haim %A Aran,Dvir %A Shelly,Shahar %+ Department of Neurology, Rambam Medical Center, HaAliya HaShniya St 8, Haifa, 3109601, Israel, 972 4 777 3568, shahar.shell@technion.ac.il %K neurology %K artificial intelligence %K telemedicine %K clinical advancements %K mobile phone %D 2024 %7 8.11.2024 %9 Viewpoint %J JMIR Neurotech %G English %X Neurological disorders are the leading cause of physical and cognitive disability across the globe, currently affecting up to 15% of the world population, with the burden of chronic neurodegenerative diseases having doubled over the last 2 decades. Two decades ago, neurologists relying solely on clinical signs and basic imaging faced challenges in diagnosis and treatment. Today, the integration of artificial intelligence (AI) and bioinformatic methods is changing this landscape. This paper explores this transformative journey, emphasizing the critical role of AI in neurology, aiming to integrate a multitude of methods and thereby enhance the field of neurology. Over the past 25 years, integrating biomedical data science into medicine, particularly neurology, has fundamentally transformed how we understand, diagnose, and treat neurological diseases. Advances in genomics sequencing, the introduction of new imaging methods, the discovery of novel molecular biomarkers for nervous system function, a comprehensive understanding of immunology and neuroimmunology shaping disease subtypes, and the advent of advanced electrophysiological recording methods, alongside the digitalization of medical records and the rise of AI, all led to an unparalleled surge in data within neurology. In addition, telemedicine and web-based interactive health platforms, accelerated by the COVID-19 pandemic, have become integral to neurology practice. The real-world impact of these advancements is evident, with AI-driven analysis of imaging and genetic data leading to earlier and more accurate diagnoses of conditions such as multiple sclerosis, Parkinson disease, amyotrophic lateral sclerosis, Alzheimer disease, and more. Neuroinformatics is the key component connecting all these advances. By harnessing the power of IT and computational methods to efficiently organize, analyze, and interpret vast datasets, we can extract meaningful insights from complex neurological data, contributing to a deeper understanding of the intricate workings of the brain. In this paper, we describe the large-scale datasets that have emerged in neurology over the last 25 years and showcase the major advancements made by integrating these datasets with advanced neuroinformatic approaches for the diagnosis and treatment of neurological disorders. We further discuss challenges in integrating AI into neurology, including ethical considerations in data use, the need for further personalization of treatment, and embracing new emerging technologies like quantum computing. These developments are shaping a future where neurological care is more precise, accessible, and tailored to individual patient needs. We believe further advancements in AI will bridge traditional medical disciplines and cutting-edge technology, navigating the complexities of neurological data and steering medicine toward a future of more precise, accessible, and patient-centric health care. %R 10.2196/59556 %U https://neuro.jmir.org/2024/1/e59556 %U https://doi.org/10.2196/59556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59247 %T Discriminant Power of Smartphone-Derived Keystroke Dynamics for Mild Cognitive Impairment Compared to a Neuropsychological Screening Test: Cross-Sectional Study %A Park,Jin-Hyuck %+ Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Room 1401, Medical Science, 22, Soonchunhayng-ro, Shinchang-myeon, Asan, 31538, Republic of Korea, 82 41 530 4773, roophy@naver.com %K digital biomarker %K motor function %K digital device %K neuropsychological screening %K screening tools %K cognitive assessment %K mild cognitive impairment %K keystroke dynamics %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) face challenges in terms of accuracy and practicality. Digital health solutions, such as unobtrusively capturing smartphone interaction data, offer a promising alternative. However, the potential of digital biomarkers as a surrogate for MCI screening remains unclear, with few comparisons between smartphone interactions and existing screening tools. Objective: This study aimed to investigate the effectiveness of smartphone-derived keystroke dynamics, captured via the Neurokeys keyboard app, in distinguishing patients with MCI from healthy controls (HCs). This study also compared the discriminant performance of these digital biomarkers against the Korean version of the Montreal Cognitive Assessment (MoCA-K), which is widely used for MCI detection in clinical settings. Methods: A total of 64 HCs and 47 patients with MCI were recruited. Over a 1-month period, participants generated 3530 typing sessions, with 2740 (77.6%) analyzed for this study. Keystroke metrics, including hold time and flight time, were extracted. Receiver operating characteristics analysis was used to assess the sensitivity and specificity of keystroke dynamics in discriminating between HCs and patients with MCI. This study also explored the correlation between keystroke dynamics and MoCA-K scores. Results: Patients with MCI had significantly higher keystroke latency than HCs (P<.001). In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=–.468; P<.001; flight time: r=–.497; P<.001), further supporting the validity of these digital biomarkers. Conclusions: These findings highlight the potential of smartphone-derived keystroke dynamics as an effective and ecologically valid tool for screening MCI. With higher sensitivity and specificity than the MoCA-K, particularly in measuring flight time, keystroke dynamics can serve as a noninvasive, scalable, and continuous method for early cognitive impairment detection. This novel approach could revolutionize MCI screening, offering a practical alternative to traditional tools in everyday settings. Trial Registration: Thai Clinical Trials Registry TCTR20220415002; https://www.thaiclinicaltrials.org/show/TCTR20220415002 %M 39475819 %R 10.2196/59247 %U https://www.jmir.org/2024/1/e59247 %U https://doi.org/10.2196/59247 %U http://www.ncbi.nlm.nih.gov/pubmed/39475819 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59018 %T Impact of Dance or Music and Meditation on the Progression of Parkinson Disease With Mild or Moderate Severity: Protocol for a Pilot Randomized Controlled Trial %A Mehrotra,Bhagyashree %A Rai,Neha %A MR,Rajani %A Budhakar,Aparna %A Aggarwal,Ritika %A Agarbattiwala,Raj Vinodkumar %A Thomas,Mona %A Patole,Sampada %A Doshi,Paresh %+ Stereotactic and Functional Neurosurgery Department, Jaslok Hospital and Research Centre, 15, G Deshmukh Marg, Pedder Road, IT Colony, Tardeo, Mumbai, 400026, India, 91 9820063854, pdoshi@neurologicalsurgery.in %K music therapy %K dance therapy %K neurodegenerative disorders %K meditation %K quality of life %K music %K pilot study %K Parkinson disease %K well-being %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunctions and nonmotor symptoms. Current treatments do not alter disease progression, highlighting the need for alternative therapies. Music, dance, and mindfulness meditation have shown the potential to improve symptoms and quality of life in patients with PD. Objective: This study aims to evaluate the effectiveness of dance or music and meditation on PD progression, cognitive functions, mood, behavior, and caregiver burden. Methods: This study is a single-blinded, longitudinal, parallel, randomized controlled trial. The participants consist of 30 patients with mild to moderate PD residing in Mumbai, India, who can physically participate in the activities. The exclusion criteria include advanced PD, severe balance issues, age >80 years, and other movement disorders. Participants in the intervention group will engage in dance or music sessions and guided meditation thrice weekly for 6 months. The control group will continue their usual activities and medication. The primary outcome is the progression of PD symptoms, measured using the Unified Parkinson’s Disease Rating Scale I-III, and quality of life, measured using the Parkinson’s Disease Questionnaire-39. The secondary outcomes include cognitive functions (Mini-Mental State Examination), mood (Beck Depression Inventory and Parkinson Anxiety Scale), mobility (timed up and go and Berg Balance Test), behavioral disorders (Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease Rating Scale), and caregiver burden (Zarit Burden Interview and Parkinson’s Disease Questionnaire-Carer). Results: Data collection was completed in February 2024, with 28 participants finishing the study (intervention group: n=15, 54% and control group: n=13, 46%). Data analysis is underway, with results expected to be published in December 2024. Conclusions: This study aims to provide significant insights into the effectiveness of dance or music and meditation in improving the quality of life and slowing the progression of PD. The findings are anticipated to support using these nonpharmaceutical therapies as complementary approaches to managing PD. Trial Registration: CTRI/2023/03/051064; https://tinyurl.com/2xdus53j International Registered Report Identifier (IRRID): DERR1-10.2196/59018 %M 39471378 %R 10.2196/59018 %U https://www.researchprotocols.org/2024/1/e59018 %U https://doi.org/10.2196/59018 %U http://www.ncbi.nlm.nih.gov/pubmed/39471378 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64525 %T Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis %A Zhu,Di %A Al Mahmud,Abdullah %A Liu,Wei %A Wang,Dahua %+ Centre for Design Innovation, School of Design and Architecture, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 392143830, aalmahmud@swin.edu.au %K mobile apps %K digital storytelling %K older adults %K mobile phone %K cognitive impairment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. Objective: This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. Methods: A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. Results: From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. Conclusions: The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps. %M 39446478 %R 10.2196/64525 %U https://aging.jmir.org/2024/1/e64525 %U https://doi.org/10.2196/64525 %U http://www.ncbi.nlm.nih.gov/pubmed/39446478 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60395 %T Intervention Development for Tailored Education for Aging and Cognitive Health (TEACH) for Dementia Prevention in Midlife Adults: Protocol for a Randomized Controlled Trial %A Korthauer,Laura E %A Rosen,Rochelle K %A Tremont,Geoffrey %A Davis,Jennifer D %+ Department of Psychiatry, Rhode Island Hospital, 1 Hoppin St., Providence, RI, 02903, United States, 1 4014444500, laura_korthauer@brown.edu %K health behavior change %K dementia prevention %K Alzheimer disease %K multidomain health intervention %K intervention development %K dementia %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A total of 12 modifiable risk factors account for 40% of dementia cases globally, yet population adherence to health behaviors associated with these factors is low. Midlife is a critical window for dementia prevention, as brain pathology often begins to accumulate years or decades before the onset of symptoms. Although multidomain behavioral interventions have been efficacious in reducing the risk of cognitive decline, adherence is low. Intrapersonal factors, such as health beliefs, are known mediators of the relationship between knowledge and health behavior. Objective: In keeping with stage I of the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development, this study will use mixed methods to (1) develop an enhanced health education intervention, including an explanatory method for communicating information about dementia risk and personal health beliefs, and (2) conduct a pilot randomized controlled trial (n=20 per intervention arm) over 8 weeks to assess the feasibility of delivering the enhanced intervention versus basic health education alone. Methods: Phase 1 will involve focus groups and individual qualitative interviews. Focus groups will be analyzed using (1) a descriptive framework matrix analysis and (2) interpretive data review by the research team. Individual qualitative interviews will be coded using applied thematic analysis using a phenomenographic approach. Phase 2 will involve a pilot randomized controlled trial. Proximal outcomes (measured at baseline, 4 weeks, and 8 weeks) include the perceived threat of Alzheimer disease, dementia awareness, and self-efficacy. Results: This project was funded in August 2022. Data collection began in 2023 and is projected to be completed in 2025. Conclusions: Study findings will reveal the feasibility of delivering an 8-week multidomain health education intervention for primary prevention of dementia in midlife and will provide preliminary evidence of mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05599425; https://clinicaltrials.gov/study/NCT05599425 International Registered Report Identifier (IRRID): DERR1-10.2196/60395 %M 39412840 %R 10.2196/60395 %U https://www.researchprotocols.org/2024/1/e60395 %U https://doi.org/10.2196/60395 %U http://www.ncbi.nlm.nih.gov/pubmed/39412840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56424 %T Effects of Combined Visual-Motor Response Training on Cognitive Function and Brain Plasticity Mechanisms in Various Populations: Protocol for a Single-Center, Open-Label, Controlled Clinical Trial %A Yu,Wenlong %A Gao,Jiamin %A Zhu,Ping %+ Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201203, China, 86 13817959206, 13817959206@126.com %K visual-motor %K response ability training %K cognitive function %K brain plasticity mechanism %K study protocol %D 2024 %7 7.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive impairment is one of the major diseases facing the aging population. The progressive decline of cognitive function can lead to declining health or even the loss of life, work, and social ability. Exercise and behavioral stimulation can increase neurotransmitters in the brain and improve overall health and cognitive function. Reactivity training can mobilize neuromuscular function and induce changes in brain plasticity, which may effectively improve cognitive dysfunction and delay the occurrence and development of Alzheimer disease; however, the evidence supporting its effectiveness is still limited. Objective: This study aims to explore the effectiveness and reliability of visual-motor reaction training in improving cognitive function, thereby promoting the application of novel nonpharmacological therapies. Methods: This study is a single-center, open-label, controlled clinical trial. A total of 78 participants will be recruited for the study, including an equal number of athletes, ordinary healthy college students, and ordinary older adults in the community. Participants will receive 2 weeks of visual-motor response training. The primary outcome of this study is to assess differences in functional magnetic resonance imaging (fMRI) at 2 weeks. The secondary outcomes were the following: acousto-optic response time, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Mini Mental State Examination (MMSE), Activity of Daily Living (ADL) Scale, Subjective Cognitive Decline Questionnaire–9 (SCD-Q9), a 10-word memory test, and safety. Results: The study was approved by the Shanghai Clinical Research Ethics Committee on January 2, 2024 (SECCR/2023-162-01). As of September 11, 2024, we have completed the recruitment of all 3 groups of volunteers. We expect to complete data collection and analysis by February 2025. Conclusions: The purpose of this study is to compare improvements in brain perceptual motor functions and cognitive levels across different populations through response ability training and to explore the efficacy and safety of exercise-based nonpharmacological therapies in improving cognitive function. Other potential benefits include understanding the functional differences and perceptual characteristics of the brain’s perceptual-motor system between athletes and the general population and exploring the adaptability of the brain in acquiring skills during competitive sports training. This could provide an evidence base for early sports talent development and broader youth development. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079602; https://tinyurl.com/23fbbndw International Registered Report Identifier (IRRID): DERR1-10.2196/56424 %M 39167080 %R 10.2196/56424 %U https://www.researchprotocols.org/2024/1/e56424 %U https://doi.org/10.2196/56424 %U http://www.ncbi.nlm.nih.gov/pubmed/39167080 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50847 %T Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Randomized Controlled Trial %A Xie,Yanhong %A Shen,Shanshan %A Liu,Caixia %A Hong,Hong %A Guan,Huilan %A Zhang,Jingmei %A Yu,Wanqi %K dementia %K family caregiver %K web-based training %K care burden %K care ability %K caregivers %K carer %K caregiving %K informal care %K RCT %K controlled trial %K randomized %K gerontology %K geriatric %K older adult %K elder %K elderly %K older person %K older people %K ageing %K aging %K dementia care %K randomized controlled trial %K internet-based training %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: As dementia progresses, patients exhibit various psychological and behavioral symptoms, imposing a significant burden on families and society, including behavioral and psychological symptoms of dementia. However, caregivers lack professional care knowledge and skills, making it difficult for them to effectively cope with the diverse challenges of caregiving. Therefore, it is necessary to provide caregivers with professional knowledge and skills guidance. Objective: This study aimed to analyze the impact of internet-based training on behavioral and psychological symptoms of dementia in patients, and explore how this training model affects the caregiving abilities and caregiving burden of the family caregivers of patients with dementia. Methods: Using a consecutive enrollment method, the Department of Geriatrics at Zhejiang Hospital (Zhejiang, China) recruited 72 informal caregivers of patients with dementia. These caregivers were randomly divided into an intervention group and a control group, with 36 participants in each group. The intervention group underwent caregiver skill training via a web-based platform, whereas the control group initially received face-to-face follow-up guidance and was subsequently offered web-based training after 6 months. To assess the effectiveness of the intervention program, we used the Neuropsychiatric Inventory Questionnaire (NPI-Q), the Chinese version of the Zarit Burden Interview (CZBI), and the Sense of Competence in Dementia Care Staff Scale (SCIDS) for evaluations conducted before the intervention, 3 months after the intervention, and 6 months after the intervention. Results: Between July 2019 and December 2020, a total of 66 patients successfully completed the intervention and follow-up. After 6 months of intervention, the NPI-Q score of the intervention group was 3.18 (SD 3.81), the CZBI score was 10.97 (SD 5.43), and the SCIDS score was 71.88 (SD 4.78). The NPI-Q score of the control group was 8.09 (SD 8.52), the CZBI score was 30.30 (SD 13.05), and the SCIDS score was 50.12 (SD 9.10). There were statistically significant differences in NPI-Q (P=.004), CZBI (P<.001), and SCIDS scores (P<.001) between the intervention group and the control group. Repeated measures analysis of variance showed that compared with before the intervention, there were statistically significant differences in CZBI (P<.001) and SCIDS (P<.001) scores 3 months after the intervention, while the difference in NPI-Q (P=.11) scores was not significant. The total scores of NPI-Q (P<.001), CZBI (P<.001), and SCIDS (P<.001) were significantly improved 6 months after the intervention. In addition, the results of the covariance analysis showed that after excluding the time effect, the web-based training intervention significantly reduced the NPI-Q score (−2.79, 95% CI −4.38 to −1.19; P<.001) of patients with dementia and the CZBI score (−13.52, 95% CI −15.87 to −11.16; P<.001) of caregivers, while increasing the SCIDS score (12.24, 95% CI 9.02-15.47; P<.001). Conclusions: Internet-based training could significantly reduce the level of behavioral symptoms in older patients with dementia and alleviate the burden on caregivers, enhancing their caregiving abilities. Our results confirmed the effectiveness and feasibility of web-based training, which was of great significance in providing caregiving knowledge training for informal caregivers of persons with dementia. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200057858; https://www.chictr.org.cn/showproj.html?proj=136442 %R 10.2196/50847 %U https://aging.jmir.org/2024/1/e50847 %U https://doi.org/10.2196/50847 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63067 %T The Impact of Social Support on the Relationship Between Physical Exercise and Cognitive Function in Older Adults: Sociological Perspective %A Li,Yuan %A Zhai,Qun %A Peng,Weihang %K social support %K physical exercise %K cognitive function %K elderly %K sociological perspective %D 2024 %7 4.10.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/63067 %U https://publichealth.jmir.org/2024/1/e63067 %U https://doi.org/10.2196/63067 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57651 %T Medication Self-Management for Home Care Users Receiving Multidose Drug Dispensing: Qualitative Interview Study %A Josendal,Anette Vik %A Bergmo,Trine Strand %K home care %K medication management %K adherence %K self-management %K multidose drug dispensing %K Norway %K primary care %K older adults %D 2024 %7 4.10.2024 %9 %J JMIR Aging %G English %X Background: Multidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. Objective: The aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. Methods: We conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants’ homes, and the interview transcripts were analyzed thematically. Results: All participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. Conclusions: MDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy. %R 10.2196/57651 %U https://aging.jmir.org/2024/1/e57651 %U https://doi.org/10.2196/57651 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55761 %T Establishing the Foundations of Emotional Intelligence in Care Companion Robots to Mitigate Agitation Among High-Risk Patients With Dementia: Protocol for an Empathetic Patient-Robot Interaction Study %A Nyamathi,Adeline %A Dutt,Nikil %A Lee,Jung-Ah %A Rahmani,Amir M %A Rasouli,Mahkameh %A Krogh,Donna %A Krogh,Erik %A Sultzer,David %A Rashid,Humayun %A Liaqat,Hamza %A Jawad,Riyam %A Azhar,Farhan %A Ahmad,Ali %A Qamar,Bilal %A Bhatti,Taha Yasin %A Khay,Chet %A Ludlow,Jocelyn %A Gibbs,Lisa %A Rousseau,Julie %A Abbasian,Mahyar %A Song,Yutong %A Jeong,Cheonkam %A Brunswicker,Sabine %+ Sue & Bill Gross School of Nursing, University of California Irvine, 854 Health Sciences Rd, Irvine, CA, 92697, United States, 1 9498248932, anyamath@hs.uci.edu %K persons with dementia %K empathy-based care companion robot %K agitation %K fall risk %K artificial intelligence %K AI %D 2024 %7 4.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: An estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy. Objective: This study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia. Methods: A design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community. Results: The study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning. Conclusions: This innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden. International Registered Report Identifier (IRRID): PRR1-10.2196/55761 %M 39365656 %R 10.2196/55761 %U https://www.researchprotocols.org/2024/1/e55761 %U https://doi.org/10.2196/55761 %U http://www.ncbi.nlm.nih.gov/pubmed/39365656 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59306 %T Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study %A Flessa,Sarah J %A Harrison,James D %A Turnigan,Roniela %A Rathfon,Megan %A Chandler,Michael %A Newton-Small,Jay %A Rogers,Stephanie E %+ Division of Geriatrics, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, Long 1556, Box #0140, San Francisco, CA, 94143, United States, 1 415 502 4929, Stephanie.Rogers@ucsf.edu %K co-design %K storytelling %K dementia %K delirium %K older adults %K person-centered care %D 2024 %7 27.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient–care team relationships and providing information to enable care tailored to individual needs and values. Objective: This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. Methods: We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. Results: In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients’ key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner–IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. Conclusions: This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting. %M 39331955 %R 10.2196/59306 %U https://aging.jmir.org/2024/1/e59306 %U https://doi.org/10.2196/59306 %U http://www.ncbi.nlm.nih.gov/pubmed/39331955 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59876 %T Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis With Ambulatory Cognitive Tests: Protocol for the Longitudinal Observational CogDetect-MS Study %A Kratz,Anna Louise %A Ehde,Dawn M %A Alschuler,Kevin N %A Pickup,Kristen %A Ginell,Keara %A Fritz,Nora E %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Building 16, Room G17-W, Ann Arbor, MI, 48109, United States, 1 734 647 5982, alkratz@med.umich.edu %K ambulatory assessment %K longitudinal data collection %K ecological momentary assessment %K cognitive function %K cognitive assessment %K multiple sclerosis %K physical activity %K neuropsychology %K physical function %K observational study %K wrist-worn accelerometry %K social function %K smartphone app %K mobile phone %D 2024 %7 26.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive dysfunction is a common problem in multiple sclerosis (MS). Progress toward understanding and treating cognitive dysfunction is thwarted by the limitations of traditional cognitive tests, which demonstrate poor sensitivity and ecological validity. Ambulatory methods of assessing cognitive function in the lived environment may improve the detection of subtle changes in cognitive function and the identification of predictors of cognitive changes and downstream effects of cognitive change on other functional domains. Objective: This paper describes the study design and protocol for the Optimizing Detection and Prediction of Cognitive Function in Multiple Sclerosis (CogDetect-MS) study, a 2-year longitudinal observational study designed to examine short- and long-term changes in cognition, predictors of cognitive change, and effects of cognitive change on social and physical function in MS. Methods: Participants—ambulatory adults with medically documented MS—are assessed over the course of 2 years on an annual basis (3 assessments: T1, T2, and T3). A comprehensive survey battery, in-laboratory cognitive and physical performance tests, and 14 days of ambulatory data collection are completed at each annual assessment. The 14-day ambulatory data collection includes continuous wrist-worn accelerometry (to measure daytime activity and sleep); ecological momentary assessments (real-time self-report) of somatic symptoms, mood, and contextual factors; and 2 brief, validated cognitive tests, administered by smartphone app 4 times per day. Our aim was to recruit 250 participants. To ensure standard test protocol administration, all examiners passed a rigorous examiner certification process. Planned analyses include (1) nonparametric 2-tailed t tests to compare in-person to ambulatory cognitive test scores; (2) mixed effects models to examine cognitive changes over time; (3) mixed effects multilevel models to evaluate whether ambulatory measures of physical activity, sleep, fatigue, pain, mood, and stress predict changes in objective or subjective measures of cognitive functioning; and (4) mixed effects multilevel models to examine whether ambulatory measures of cognitive functioning predict social and physical functioning over short (within-day) and long (over years) time frames. Results: The study was funded in August 2021 and approved by the University of Michigan Medical Institutional Review Board on January 27, 2022. A total of 274 adults with MS (first participant enrolled on May 12, 2022) have been recruited and provided T1 data. Follow-up data collection will continue through March 2026. Conclusions: Results from the CogDetect-MS study will shed new light on the temporal dynamics of cognitive function, somatic and mood symptoms, sleep, physical activity, and physical and social function. These insights have the potential to improve our understanding of changes in cognitive function in MS and enable us to generate new interventions to maintain or improve cognitive function in those with MS. Trial Registration: ClinicalTrials.gov NCT05252195; https://clinicaltrials.gov/study/NCT05252195 International Registered Report Identifier (IRRID): DERR1-10.2196/59876 %M 39325510 %R 10.2196/59876 %U https://www.researchprotocols.org/2024/1/e59876 %U https://doi.org/10.2196/59876 %U http://www.ncbi.nlm.nih.gov/pubmed/39325510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56878 %T Ascertaining Out-of-Pocket Costs of Dementia Care: Feasibility Study of a Web-Based Weekly Survey %A Dawson,Walter D %A Mattek,Nora %A Gothard,Sarah %A Kaye,Jeffrey %A Lindauer,Allison %+ Oregon Alzheimer’s Disease Research Center, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, CR131, Portland, OR, 97239, United States, 1 5034946976, dawsonw@ohsu.edu %K Alzheimer disease %K caregiving %K out-of-pocket costs %K behavioral and psychological symptoms of dementia %K technological interventions %K clinical trials %K dementias %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caring for a family member living with dementia is costly. A major contributor to care demands, and therefore to the costs, are the behavioral symptoms of dementia. Here, we examine the feasibility of ascertaining costs related to caregiving from weekly web-based surveys collected during a telehealth-based behavioral intervention study—Support via Technology: Living and Learning with Advancing Alzheimer Disease. Objective: This study aims to determine the feasibility and acceptability of using a web-based weekly survey to capture real-time data on out-of-pocket caregiving expenses and time commitments associated with dementia care. To examine relationships between behavioral symptoms, care partner reactivity, burden, and out-of-pocket dementia care costs. Methods: Feasibility was measured by accrual, retention, and data completion by participating care partners. Behavioral symptoms, care partner reactivity, and burden were collected before and after the intervention from 13 care partners. Weekly web-based surveys queried Support via Technology: Living and Learning with Advancing Alzheimer Disease care partners about their out-of-pocket costs associated with care-related activities. The surveys included questions on out-of-pocket costs care partners incurred from hospitalizations and emergency department use, primary care provider visits, use of paid in-home care or respite services, use of prescription medications, and use of over-the-counter medications. The surveys also queried the amount of time care partners devoted to these specific care–related activities. Results: Out-of-pocket costs of dementia care were collected via a web-based weekly survey for up to 18 months. In-home assistance was the most frequently reported type of out-of-pocket care expense and the costliest. care partners who paid for in-home assistance or respite reported more behavioral and psychological symptoms of dementia behaviors, higher reactivity, and higher burden than those who did not. Conclusions: This novel web-based weekly survey–based approach offers lessons for designing and implementing future cost-focused studies and care partner–supportive telehealth-based interventions for Alzheimer disease and related dementias (ADRD). The results correspond with the existing understanding of ADRD in that high family-related out-of-pocket costs are a typical part of the caregiving experience, and those costs likely increase with dementia severity. The results may also offer potential insights to health systems and policy makers as they seek to implement telehealth-based and related interventions that seek to better support people living with ADRD and their family care partners. Trial Registration: ClinicalTrials.gov NCT04335110; https://clinicaltrials.gov/ct2/show/NCT04335110 %M 39321453 %R 10.2196/56878 %U https://formative.jmir.org/2024/1/e56878 %U https://doi.org/10.2196/56878 %U http://www.ncbi.nlm.nih.gov/pubmed/39321453 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e57926 %T Extracting Critical Information from Unstructured Clinicians’ Notes Data to Identify Dementia Severity Using a Rule-Based Approach: Feasibility Study %A Prakash,Ravi %A Dupre,Matthew E %A Østbye,Truls %A Xu,Hanzhang %+ Department of Family Medicine and Community Health, School of Medicine, Duke Univeristy, 2100 Erwin Rd, Durham, NC, 27710, United States, 1 9196849465, hanzhang.xu@duke.edu %K electronic health record %K EHR %K electric medical record %K EMR %K patient record %K health record %K personal health record %K PHR %K unstructured data %K rule based analysis %K artificial intelligence %K AI %K large language model %K LLM %K natural language processing %K NLP %K deep learning %K Alzheimer's disease and related dementias %K AD %K ADRD %K Alzheimer's disease %K dementia %K geriatric syndromes %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The severity of Alzheimer disease and related dementias (ADRD) is rarely documented in structured data fields in electronic health records (EHRs). Although this information is important for clinical monitoring and decision-making, it is often undocumented or “hidden” in unstructured text fields and not readily available for clinicians to act upon. Objective: We aimed to assess the feasibility and potential bias in using keywords and rule-based matching for obtaining information about the severity of ADRD from EHR data. Methods: We used EHR data from a large academic health care system that included patients with a primary discharge diagnosis of ADRD based on ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes between 2014 and 2019. We first assessed the presence of ADRD severity information and then the severity of ADRD in the EHR. Clinicians’ notes were used to determine the severity of ADRD based on two criteria: (1) scores from the Mini Mental State Examination and Montreal Cognitive Assessment and (2) explicit terms for ADRD severity (eg, “mild dementia” and “advanced Alzheimer disease”). We compiled a list of common ADRD symptoms, cognitive test names, and disease severity terms, refining it iteratively based on previous literature and clinical expertise. Subsequently, we used rule-based matching in Python using standard open-source data analysis libraries to identify the context in which specific words or phrases were mentioned. We estimated the prevalence of documented ADRD severity and assessed the performance of our rule-based algorithm. Results: We included 9115 eligible patients with over 65,000 notes from the providers. Overall, 22.93% (2090/9115) of patients were documented with mild ADRD, 20.87% (1902/9115) were documented with moderate or severe ADRD, and 56.20% (5123/9115) did not have any documentation of the severity of their ADRD. For the task of determining the presence of any ADRD severity information, our algorithm achieved an accuracy of >95%, specificity of >95%, sensitivity of >90%, and an F1-score of >83%. For the specific task of identifying the actual severity of ADRD, the algorithm performed well with an accuracy of >91%, specificity of >80%, sensitivity of >88%, and F1-score of >92%. Comparing patients with mild ADRD to those with more advanced ADRD, the latter group tended to contain older, more likely female, and Black patients, and having received their diagnoses in primary care or in-hospital settings. Relative to patients with undocumented ADRD severity, those with documented ADRD severity had a similar distribution in terms of sex, race, and rural or urban residence. Conclusions: Our study demonstrates the feasibility of using a rule-based matching algorithm to identify ADRD severity from unstructured EHR report data. However, it is essential to acknowledge potential biases arising from differences in documentation practices across various health care systems. %M 39316421 %R 10.2196/57926 %U https://aging.jmir.org/2024/1/e57926 %U https://doi.org/10.2196/57926 %U http://www.ncbi.nlm.nih.gov/pubmed/39316421 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56549 %T Development of a Dementia Case Management Information System App: Mixed Methods Study %A Huang,Huei-Ling %A Chao,Yi-Ping %A Kuo,Chun-Yu %A Sung,Ya-Li %A Shyu,Yea-Ing L %A Hsu,Wen-Chuin %+ Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, No.261, Wenhua 1st Road, Guishan District, Taoyuan City, 33303, Taiwan, 886 32118999 ext 5803, hlhuang@gw.cgust.edu.tw %K case management %K dementia %K health information systems %K mobile apps %K user needs %K mobile phone %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care. Objective: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app. Methods: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience. Results: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app. Conclusions: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan. %M 39312770 %R 10.2196/56549 %U https://aging.jmir.org/2024/1/e56549 %U https://doi.org/10.2196/56549 %U http://www.ncbi.nlm.nih.gov/pubmed/39312770 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64446 %T Prescribing Trends and Associated Outcomes of Antiepileptic Drugs and Other Psychotropic Medications in US Nursing Homes: Proposal for a Mixed Methods Investigation %A Winter,Jonathan D %A Kerns,J William %A Brandt,Nicole %A Wastila,Linda %A Qato,Danya %A Sabo,Roy T %A Petterson,Stephen %A Chung,YoonKyung %A Reves,Sarah %A Winter,Christopher %A Winter,Katherine M %A Elonge,Eposi %A Ewasiuk,Craig %A Fu,Yu-Hua %A Funk,Adam %A Krist,Alex %A Etz,Rebecca %+ Department of Family Medicine and Population Health, School of Medicine, Viginia Commonwealth University, 1001 East Leight St, Richmond, VA, 23219, United States, 1 5406313700, jwinter@valleyhealthlink.com %K Alzheimer disease %K dementia %K antiepileptic drug %K antiseizure medication %K antipsychotic %K National Partnership %K nursing home %K mood stabilizer %K COVID-19 %D 2024 %7 19.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Pilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. Objective: Using a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. Methods: To accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services’ (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. Results: Funding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. Conclusions: This study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. International Registered Report Identifier (IRRID): DERR1-10.2196/64446 %M 39298758 %R 10.2196/64446 %U https://www.researchprotocols.org/2024/1/e64446 %U https://doi.org/10.2196/64446 %U http://www.ncbi.nlm.nih.gov/pubmed/39298758 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62654 %T Education Program for Enhancing Health Care Students’ Attitudes Toward People Living With Dementia: Protocol for a Single-Arm Pre-Post Study %A Sari,Dianis Wulan %A Kugai,Haruna %A Igarashi,Ayumi %A Takaoka,Manami %A Matsumoto,Hiroshige %A Suzuki,Haruno %A Wu,Jinyan %A Fitryasari,Rizki %A Nasifah,Ike Ayunda %A Has,Eka Mishbahatul M %A Yamamoto-Mitani,Noriko %+ Faculty of Nursing, Universitas Airlangga, jl mulyorejo, Surabaya, 60115, Indonesia, 62 5913257, dianis.wulan.sari@fkp.unair.ac.id %K ageism %K dementia %K health professional %K education program %K long-term care %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care students are instrumental in shaping the future of dementia care. Cultivating a positive attitude and understanding toward people living with dementia is crucial for diminishing the stigma associated with the condition, providing effective and person-centered care, and enhancing the quality of life for people living with dementia. Educational programs about dementia are increasingly recognizing the potential of gaming tools. Objective: This study aimed to evaluate the effectiveness of gaming-based dementia educational programs in improving attitudes toward people living with dementia among health care students. Methods: This single-arm pre-post study will be conducted among health care students in Indonesian universities. This educational program based on gaming tools will consist of a lecture on dementia, the use of N-impro (gaming tool), and the enactment of short dramas depicting desirable and undesirable communication with people living with dementia behaviors. We will assess attitudes toward people living with dementia, intention to help people living with dementia, knowledge of dementia, and the stigma associated with people living with dementia. The gaming-based dementia education program will be integrated into the curriculum of the health care students. The program will be implemented once with a duration of 90 minutes. Results: Data collection will occur from August 2023 to March 2024. Analysis of the data will be finalized by May 2024, and the outcome will be determined by July 2024. The impact of the gaming-based dementia educational program on improving attitudes toward people living with dementia will be reported. The study findings will be published in a peer-reviewed journal. Conclusions: The gaming education program demonstrates significant potential in enhancing attitudes toward people living with dementia across various countries, introducing an innovative method for the community-based support of people living with dementia. Trial Registration: ClinicalTrials.gov NCT06122623; https://clinicaltrials.gov/study/NCT06122623 International Registered Report Identifier (IRRID): DERR1-10.2196/62654 %M 39293050 %R 10.2196/62654 %U https://www.researchprotocols.org/2024/1/e62654 %U https://doi.org/10.2196/62654 %U http://www.ncbi.nlm.nih.gov/pubmed/39293050 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53793 %T Predicting Adherence to Computer-Based Cognitive Training Programs Among Older Adults: Study of Domain Adaptation and Deep Learning %A Singh,Ankita %A Chakraborty,Shayok %A He,Zhe %A Pang,Yuanying %A Zhang,Shenghao %A Subedi,Ronast %A Lustria,Mia Liza %A Charness,Neil %A Boot,Walter %K domain adaptation %K adherence %K cognitive training %K deep neural networks %K early detection of cognitive decline %D 2024 %7 16.9.2024 %9 %J JMIR Aging %G English %X Background: Cognitive impairment and dementia pose a significant challenge to the aging population, impacting the well-being, quality of life, and autonomy of affected individuals. As the population ages, this will place enormous strain on health care and economic systems. While computerized cognitive training programs have demonstrated some promise in addressing cognitive decline, adherence to these interventions can be challenging. Objective: The objective of this study is to improve the accuracy of predicting adherence lapses to ultimately develop tailored adherence support systems to promote engagement with cognitive training among older adults. Methods: Data from 2 previously conducted cognitive training intervention studies were used to forecast adherence levels among older participants. Deep convolutional neural networks were used to leverage their feature learning capabilities and predict adherence patterns based on past behavior. Domain adaptation (DA) was used to address the challenge of limited training data for each participant, by using data from other participants with similar playing patterns. Time series data were converted into image format using Gramian angular fields, to facilitate clustering of participants during DA. To the best of our knowledge, this is the first effort to use DA techniques to predict older adults’ daily adherence to cognitive training programs. Results: Our results demonstrated the promise and potential of deep neural networks and DA for predicting adherence lapses. In all 3 studies, using 2 independent datasets, DA consistently produced the best accuracy values. Conclusions: Our findings highlight that deep learning and DA techniques can aid in the development of adherence support systems for computerized cognitive training, as well as for other interventions aimed at improving health, cognition, and well-being. These techniques can improve engagement and maximize the benefits of such interventions, ultimately enhancing the quality of life of individuals at risk for cognitive impairments. This research informs the development of more effective interventions, benefiting individuals and society by improving conditions associated with aging. %R 10.2196/53793 %U https://aging.jmir.org/2024/1/e53793 %U https://doi.org/10.2196/53793 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54655 %T Investigating Acoustic and Psycholinguistic Predictors of Cognitive Impairment in Older Adults: Modeling Study %A Badal,Varsha D %A Reinen,Jenna M %A Twamley,Elizabeth W %A Lee,Ellen E %A Fellows,Robert P %A Bilal,Erhan %A Depp,Colin A %+ IBM Research, 1101 Kitchawan Rd, Yorktown Heights, NY, United States, 1 9149453000, ebilal@us.ibm.com %K acoustic %K psycholinguistic %K speech %K speech marker %K speech markers %K cognitive impairment %K CI %K mild cognitive impairment %K MCI %K cognitive disability %K cognitive restriction %K cognitive limitation %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K predictive model %K predictive models %K predictive analytics %K predictive system %K practical model %K practical models %K early warning %K early detection %K NLP %K natural language processing %K Alzheimer %K dementia %K neurological decline %K neurocognition %K neurocognitive disorder %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: About one-third of older adults aged 65 years and older often have mild cognitive impairment or dementia. Acoustic and psycho-linguistic features derived from conversation may be of great diagnostic value because speech involves verbal memory and cognitive and neuromuscular processes. The relative decline in these processes, however, may not be linear and remains understudied. Objective: This study aims to establish associations between cognitive abilities and various attributes of speech and natural language production. To date, the majority of research has been cross-sectional, relying mostly on data from structured interactions and restricted to textual versus acoustic analyses. Methods: In a sample of 71 older (mean age 83.3, SD 7.0 years) community-dwelling adults who completed qualitative interviews and cognitive testing, we investigated the performance of both acoustic and psycholinguistic features associated with cognitive deficits contemporaneously and at a 1-2 years follow up (mean follow-up time 512.3, SD 84.5 days). Results: Combined acoustic and psycholinguistic features achieved high performance (F1-scores 0.73-0.86) and sensitivity (up to 0.90) in estimating cognitive deficits across multiple domains. Performance remained high when acoustic and psycholinguistic features were used to predict follow-up cognitive performance. The psycholinguistic features that were most successful at classifying high cognitive impairment reflected vocabulary richness, the quantity of speech produced, and the fragmentation of speech, whereas the analogous top-ranked acoustic features reflected breathing and nonverbal vocalizations such as giggles or laughter. Conclusions: These results suggest that both acoustic and psycholinguistic features extracted from qualitative interviews may be reliable markers of cognitive deficits in late life. %M 39283659 %R 10.2196/54655 %U https://aging.jmir.org/2024/1/e54655 %U https://doi.org/10.2196/54655 %U http://www.ncbi.nlm.nih.gov/pubmed/39283659 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53640 %T Determinants of Successful Implementation of Assistive Technologies for Dementia: Exploratory Survey %A Van der Roest,Henriëtte Geralde %A Christie,Hannah Liane %A Franco-Martin,Manuel Angel %A Dröes,Rose-Marie %A de Vugt,Marjolein Elizabeth %A Meiland,Franka %K assistive technology %K dementia %K implementation %K caregiving %K psychosocial research %D 2024 %7 13.9.2024 %9 %J JMIR Aging %G English %X Background: Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective: We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods: A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results: The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions: This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia. %R 10.2196/53640 %U https://aging.jmir.org/2024/1/e53640 %U https://doi.org/10.2196/53640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53727 %T Physical Activity Mobile App (CareFit) for Informal Carers of People With Dementia: Protocol for a Feasibility and Adaptation Study %A Egan,Kieren %A Macdonald,Bradley %A Hodgson,William %A Kirk,Alison %A Fawcett,Barbara %A Dunlop,Mark D %A Maguire,Roma %A Flynn,Greg %A Stott,Joshua %A Windle,Gill %+ Digital Health and Wellness Research Group (DHAWG), University of Strathclyde, Livingstone Tower, 26 Richmond St, Glasgow, G1 1XQ, United Kingdom, 44 141 548 3189, kieren.egan@strath.ac.uk %K carers %K dementia %K physical activity %K sedentary %K cross platform app %K caregivers %K mobile phone %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity is a critical component of both well-being and preventative health, reducing the risk of both chronic mental and physical conditions and early death. Yet, there are numerous groups in society who are not able to undertake as much physical activity as they would like to. This includes informal (unpaid) carers, with the United Kingdom national survey data suggesting that 81% would like to do more physical activity on a regular basis. There is a clear need to develop innovations, including digital interventions that hold implementation potential to support regular physical activity in groups such as carers. Objective: This study aims to expand and personalize a cross-platform digital health app designed to support regular physical activity in carers of people with dementia for a period of 8 weeks and evaluate the potential for implementation. Methods: The CareFit for dementia carers study was a mixed methods co-design, development, and evaluation of a novel motivational smartphone app to support home-based regular physical activity for unpaid dementia carers. The study was planned to take place across 16 months in total (September 1, 2022, to December 31, 2023). The first phase included iterative design sprints to redesign an initial prototype for widespread use, supported through a bespoke content management system. The second phase included the release of the “CareFit” app across Scotland through invitations on the Apple and Google stores where we aimed to recruit 50 carers and up to 20 professionals to support the delivery in total. Partnerships for the work included a range of stakeholders across charities, health and social care partnerships, physical activity groups, and carers’ organizations. We explored the implementation of CareFit, guided by both Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Complex Intervention Frameworks. Results: Project processes and outcomes were evaluated using mixed methods. The barriers and enablers for professional staff to signpost and use CareFit with clients were assessed through interviews or focus groups and round stakeholder meetings. The usability of CareFit was explored through qualitative interviews with carers and a system usability scale. We examined how CareFit could add value to carers by examining “in-app” data, pre-post questionnaire responses, and qualitative work, including interviews and focus groups. We also explored how CareFit could add value to the landscape of other online resources for dementia carers. Conclusions: Results from this study will contribute new knowledge including identifying (1) suitable pathways to identify and support carers through digital innovations; (2) future design of definitive studies in carer populations; and (3) an improved understanding of the Reach, Effectiveness, Adoption, Implementation, and Maintenance across a range of key stakeholders. International Registered Report Identifier (IRRID): DERR1-10.2196/53727 %M 39265159 %R 10.2196/53727 %U https://www.researchprotocols.org/2024/1/e53727 %U https://doi.org/10.2196/53727 %U http://www.ncbi.nlm.nih.gov/pubmed/39265159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57809 %T Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Liu,Justina %A Sin,Olive Suk Kan %A Fong,Kenneth N K %A Qin,Jing %A Wong,Joe Chi Yin %A Lai,Claudia %+ School of Nursing, Tung Wah College, 31 Wylie Road, Homantin, Hong Kong, NA, China (Hong Kong), 852 34686813, rickkwan@twc.edu.hk %K virtual reality %K motor-cognitive training %K cognitive frailty %K gamification %D 2024 %7 11.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive frailty refers to a clinical syndrome in which physical frailty and mild cognitive impairment coexist. Motor-cognitive training and virtual reality (VR) have been used to launch various therapeutic modalities to promote health in older people. The literature advocates that motor-cognitive training and VR are effective in promoting the cognitive and physical function of older people. However, the effects on older people with cognitive frailty are unclear. Objective: This study examined the effects of VR motor-cognitive training (VRMCT) on global cognitive function, physical frailty, walking speed, visual short-term memory, inhibition of cognitive interference, and executive function in older people with cognitive frailty. Methods: This study used a multicentered, assessor-blinded, 2-parallel-group randomized controlled trial design. Participants were recruited face-to-face in 8 older adult community centers. Eligible participants were aged ≥60 years, were community dwelling, lived with cognitive frailty, had no dementia, and were not mobility restricted. In the intervention group, participants received VRMCT led by interventionists with 16 one-hour training sessions delivered twice per week for 8 weeks. In the control group, participants received the usual care provided by the older adult community centers that the investigators did not interfere with. The primary outcome was global cognitive function. The secondary outcomes included physical frailty, walking speed, verbal short-term memory, inhibition of cognitive interference, and executive function. Data were collected at baseline (T0) and the week after the intervention (T1). Generalized estimating equations were used to examine the group, time, and interaction (time × group) effects on the outcomes. Results: In total, 293 eligible participants enrolled in the study. The mean age of the participants was 74.5 (SD 6.8) years. Most participants were female (229/293, 78.2%), had completed primary education (152/293, 52.1%), were married (167/293, 57.2%), lived with friends (127/293, 43.3%), and had no VR experience (232/293, 79.5%). In the intervention group, 81.6% (119/146) of participants attended >80% (13/16, 81%) of the total number of sessions. A negligible number of participants experienced VR sickness symptoms (1/146, 0.7% to 5/146, 3%). VRMCT was effective in promoting global cognitive function (interaction effect: P=.03), marginally promoting executive function (interaction effect: P=.07), and reducing frailty (interaction effect: P=.03). The effects were not statistically significant on other outcomes. Conclusions: VRMCT is effective in promoting cognitive functions and reducing physical frailty and is well tolerated and accepted by older people with cognitive frailty, as evidenced by its high attendance rate and negligible VR sickness symptoms. Further studies should examine the efficacy of the intervention components (eg, VR vs non-VR or dual task vs single task) on health outcomes, the effect of using technology on intervention adherence, and the long-term effects of the intervention on older people with cognitive frailty at the level of daily living. Trial Registration: ClinicalTrials.gov NCT04730817; https://clinicaltrials.gov/study/NCT04730817 %M 39259959 %R 10.2196/57809 %U https://www.jmir.org/2024/1/e57809 %U https://doi.org/10.2196/57809 %U http://www.ncbi.nlm.nih.gov/pubmed/39259959 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54186 %T Everyday Uses of Music Listening and Music Technologies by Caregivers and People With Dementia: Survey and Focus Group Study %A Vidas,Dianna %A Carrasco,Romina %A Kelly,Ryan M %A Waycott,Jenny %A Tamplin,Jeanette %A McMahon,Kate %A Flynn,Libby M %A Stretton-Smith,Phoebe A %A Sousa,Tanara Vieira %A Baker,Felicity A %+ School of Computing and Information Systems, The University of Melbourne, Grattan Street, Parkville, 3010, Australia, 61 3 90355511, dianna.vidas@unimelb.edu.au %K dementia %K dementia care %K technology %K music technology %K mobile phone %D 2024 %7 27.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Music has long been identified as a nonpharmacological tool that can provide benefits for people with dementia, and there is considerable interest in designing technologies to support the use of music in dementia care. However, to ensure that music technologies are appropriately designed for supporting caregivers and people living with dementia, there remains a need to better understand how music is currently used in everyday dementia care at home. Objective: This study aims to understand how people living with dementia and their caregivers use music and music technologies in everyday caring, as well as the challenges they experience using music and technology. Methods: This study used a mixed methods design. First, a survey was administered to 13 people living with dementia and 64 caregivers to understand their use of music and technology. Subsequently, 18 survey respondents (family caregivers: n=12, 67%; people living with dementia: n=6, 33%) participated in focus groups regarding their experiences of using music and technology in care. Interview transcripts were analyzed using reflexive thematic analysis. Results: Most of the survey respondents (people living with dementia: 9/13, 69%; family caregivers: 47/63, 75%) reported using music often or very often in their daily lives. Participants reported a range of technologies used for listening to music, such as CDs, radio, and streaming services. Focus groups highlighted the benefits and challenges of using music and music technologies in everyday care. Participants identified using music and music technologies to regulate mood, provide joy, facilitate social interaction and connection, encourage reminiscence, provide continuity of music use before and after the dementia diagnosis, and make caregiving easier. The challenges of using music technology in everyday caring included difficulties with staying up to date with evolving technology and low self-efficacy with technology for people living with dementia. Conclusions: This study shows that people with a dementia diagnosis and their caregivers already use music and music technologies to support their everyday care needs. The results suggest opportunities to design technologies that enable easier access to music and to support people living with dementia with recreational and therapeutic music listening as well as music-based activities. %R 10.2196/54186 %U https://www.jmir.org/2024/1/e54186 %U https://doi.org/10.2196/54186 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56055 %T Optimizing Technology-Based Prompts for Supporting People Living With Dementia in Completing Activities of Daily Living at Home: Experimental Approach to Prompt Modality, Task Breakdown, and Attentional Support %A Cannings,Madeleine %A Brookman,Ruth %A Parker,Simon %A Hoon,Leonard %A Ono,Asuka %A Kawata,Hiroaki %A Matsukawa,Hisashi %A Harris,Celia B %+ The MARCS Institute for Brain, Behaviour, and Development, Western Sydney University, Locked Bag 1797, Penrith, 2571, Australia, 61 297726570, celia.harris@westernsydney.edu.au %K assistive technology %K accessible technology %K accessibility technology %K assistive technologies %K accessible technologies %K assistive device %K assistive devices %K dementia %K people living with dementia %K dementia care %K person-centered technology %K patient-centered technology %K person-centered technologies %K patient-centered technologies %K memory support %K prompting %K user-computer interface %K user interface %K UI %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K mobile phone %D 2024 %7 23.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Assistive technology is becoming increasingly accessible and affordable for supporting people with dementia and their care partners living at home, with strong potential for technology-based prompting to assist with initiation and tracking of complex, multistep activities of daily living. However, there is limited direct comparison of different prompt features to guide optimal technology design. Objective: Across 3 experiments, we investigated the features of tablet-based prompts that best support people with dementia to complete activities of daily living at home, measuring prompt effectiveness and gaining feedback from people with dementia and their care partners about their experiences. Methods: Across experiments, we developed a specialized iPad app to enable data collection with people with dementia at home over an extended experimental period. In experiment 1, we varied the prompts in a 3 (visual type: text instruction, iconic image, and photographic image) × 3 (audio type: no sound, symbolic sound, and verbal instruction) experimental design using repeated measures across multiple testing sessions involving single-step activities. In experiment 2, we tested the most effective prompt breakdown for complex multistep tasks comparing 3 conditions (1-prompt, 3-prompt, and 7-prompt conditions). In experiment 3, we compared initiation and maintenance alerts that involved either an auditory tone or an auditory tone combined with a verbal instruction. Throughout, we asked people with dementia and their care partners to reflect on the usefulness of prompting technology in their everyday lives and what could be developed to better meet their needs. Results: First, our results showed that audible verbal instructions were more useful for task completion than either tone-based or visual prompts. Second, a more granular breakdown of tasks was generally more useful and increased independent use, but this varied across individuals. Third, while a voice or text maintenance alert enabled people with dementia to persist with a multistep task for longer when it was more frequent, task initiation still frequently required support from a care partner. Conclusions: These findings can help inform developers of assistive technology about the design features that promote the usefulness of home prompting systems for people with dementia as well as the preferences and insights of people with dementia and their care partners regarding assistive technology design. %M 39178405 %R 10.2196/56055 %U https://aging.jmir.org/2024/1/e56055 %U https://doi.org/10.2196/56055 %U http://www.ncbi.nlm.nih.gov/pubmed/39178405 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55126 %T Detection of Mild Cognitive Impairment From Non-Semantic, Acoustic Voice Features: The Framingham Heart Study %A Ding,Huitong %A Lister,Adrian %A Karjadi,Cody %A Au,Rhoda %A Lin,Honghuang %A Bischoff,Brian %A Hwang,Phillip H %+ Department of Epidemiology, Boston University School of Public Health, T3E, 715 Albany Street, Boston, MA, 02118, United States, 1 (617) 358 4049, phhwang@bu.edu %K early detection %K Alzheimer disease and related dementias %K mild cognitive impairment %K digital voice %K machine learning %K smartphone %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Aging %G English %X Background: With the aging global population and the rising burden of Alzheimer disease and related dementias (ADRDs), there is a growing focus on identifying mild cognitive impairment (MCI) to enable timely interventions that could potentially slow down the onset of clinical dementia. The production of speech by an individual is a cognitively complex task that engages various cognitive domains. The ease of audio data collection highlights the potential cost-effectiveness and noninvasive nature of using human speech as a tool for cognitive assessment. Objective: This study aimed to construct a machine learning pipeline that incorporates speaker diarization, feature extraction, feature selection, and classification to identify a set of acoustic features derived from voice recordings that exhibit strong MCI detection capability. Methods: The study included 100 MCI cases and 100 cognitively normal controls matched for age, sex, and education from the Framingham Heart Study. Participants' spoken responses on neuropsychological tests were recorded, and the recorded audio was processed to identify segments of each participant's voice from recordings that included voices of both testers and participants. A comprehensive set of 6385 acoustic features was then extracted from these voice segments using OpenSMILE and Praat software. Subsequently, a random forest model was constructed to classify cognitive status using the features that exhibited significant differences between the MCI and cognitively normal groups. The MCI detection performance of various audio lengths was further examined. Results: An optimal subset of 29 features was identified that resulted in an area under the receiver operating characteristic curve of 0.87, with a 95% CI of 0.81-0.94. The most important acoustic feature for MCI classification was the number of filled pauses (importance score=0.09, P=3.10E–08). There was no substantial difference in the performance of the model trained on the acoustic features derived from different lengths of voice recordings. Conclusions: This study showcases the potential of monitoring changes to nonsemantic and acoustic features of speech as a way of early ADRD detection and motivates future opportunities for using human speech as a measure of brain health. %M 39173144 %R 10.2196/55126 %U https://aging.jmir.org/2024/1/e55126 %U https://doi.org/10.2196/55126 %U http://www.ncbi.nlm.nih.gov/pubmed/39173144 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e54724 %T Use of Immersive Virtual Reality in Nursing Homes for People With Dementia: Feasibility Study to Assess Cognitive, Motor, and Emotional Responses %A Prinz,Alexander %A Buerger,Dan %A Krafft,Jelena %A Bergmann,Matteo %A Woll,Alexander %A Barisch-Fritz,Bettina %A Witte,Kerstin %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 49049244, bettina.barisch-fritz@kit.edu %K persons with dementia %K virtual reality %K VR %K immersive virtual reality %K iVR %K head-mounted display %K HMD %K physical performance %K physical activity %K physical function %K motor performance %K Alzheimer’s disease %K Alzheimer’s %K Alzheimer’s treatment %K Alzheimer’s care %K Alzheimer’s symptom control %K dementia %K dementia therapy %K dementia care %K cognitive decline %K cognitive impairment %K cognitive impairments %K neurocognition %K neurology %K neurologist %K neurologists %K nursing home %K nursing homes %K nursing facility %K senior home %K long-term care center %K long-term care facility %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Physical activity interventions for people with dementia have shown promising effects in improving cognition and physical function or slowing disease-related decline. Immersive virtual reality (iVR), using head-mounted displays, facilitates realistic experiences by blurring the boundaries between VR and the real world. The use of iVR for people with dementia offers the potential to increase active time and improve dementia therapy and care through exercise interventions. However, the feasibility of using VR use in people with dementia, considering changes in motor, cognitive, psychological, and physiological parameters, remains insufficiently investigated. Objective: This study aims to investigate the feasibility of using iVR in people with dementia or mild cognitive impairment in nursing homes. Specifically, we examined changes in motor performance (balance and mobility), cognitive performance (global cognition and executive functions), emotional responses, and fear of falling using iVR. Methods: Utilizing a pre-post design, this study recruited 35 participants with mild-to-moderate dementia, assessed by the Mini-Mental State Examination (MMSE). Participants underwent a single session involving iVR exposure, with pre- and postexposure assessments and a feedback form, to exclude negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance. The use of iVR involved 4 scenes, with a total length of 8 minutes. These scenes depicted a park with short and rather passive impressions presented as a 360° video in a head-mounted display. Before and after using the iVR, cognitive parameters were assessed using the Trail-Making Test A (TMT-A), motor parameters were assessed using the FICSIT-4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques-4) and Timed-Up-and-Go (TUG) tests, and psychological parameters were assessed using the Dementia Mood Picture Test, State-Trait Anxiety Inventory, and Short Falls Efficacy Scale-International (Short FES-I). The Emotion Rating Scale and the duration of use were recorded during use, and a feedback questionnaire was completed afterward in addition to the posttests. Paired t tests and Wilcoxon tests were used to examine pre-post differences. Results: Of the 35 initial participants, 33 completed the study, which corresponds to a dropout rate of 6%. All 33 participants, who had a mean of 83.71 (SD 5.01) years, had dementia. They showed no statistically significant difference in cognitive and motor performance before and after iVR use. Thus, no negative effects on cognitive and motor functions, mood, anxiety levels, and balance performance were observed. The emotion rating scale also showed that 72% (n=24) felt joy and fun during iVR use, 100% (n=33) showed no emotions such as fear, sadness, or anger, and 93% (n=31) were attentive during iVR use. Conclusions: The feasibility of using iVR for people with dementia can be rated positively. There were no changes in motor, cognitive, or emotional parameters that would increase the risk of falls or other negative emotional reactions during or after iVR use. Further studies are needed to investigate prolonged use in a more stimulating computer-generated environment and possible physical and cognitive tasks for people with dementia in nursing homes. Trial Registration: German Clinical Trials Register DRKS00030616; https://drks.de/search/de/trial/DRKS00030616 %R 10.2196/54724 %U https://xr.jmir.org/2024/1/e54724 %U https://doi.org/10.2196/54724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49794 %T The Dual Task Ball Balancing Test and Its Association With Cognitive Function: Algorithm Development and Validation %A Greene,Barry %A Tobyne,Sean %A Jannati,Ali %A McManus,Killian %A Gomes Osman,Joyce %A Banks,Russell %A Kher,Ranjit %A Showalter,John %A Bates,David %A Pascual-Leone,Alvaro %+ Linus Health, 280 Summer St, Boston, MA, 02210, United States, 1 851682046, kmcmanus@linus.health %K cognitive function %K dual task %K inertial sensors %K mHealth %K tablet %K MCI %K Alzheimer %K dementia %K motor %K older adults %K cognitive impairment %K balance
 %D 2024 %7 19.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Dual task paradigms are thought to offer a quantitative means to assess cognitive reserve and the brain’s capacity to allocate resources in the face of competing cognitive demands. The most common dual task paradigms examine the interplay between gait or balance control and cognitive function. However, gait and balance tasks can be physically challenging for older adults and may pose a risk of falls. Objective: We introduce a novel, digital dual-task assessment that combines a motor-control task (the “ball balancing” test), which challenges an individual to maintain a virtual ball within a designated zone, with a concurrent cognitive task (the backward digit span task [BDST]). Methods: The task was administered on a touchscreen tablet, performance was measured using the inertial sensors embedded in the tablet, conducted under both single- and dual-task conditions. The clinical use of the task was evaluated on a sample of 375 older adult participants (n=210 female; aged 73.0, SD 6.5 years). Results: All older adults, including those with mild cognitive impairment (MCI) and Alzheimer disease–related dementia (ADRD), and those with poor balance and gait problems due to diabetes, osteoarthritis, peripheral neuropathy, and other causes, were able to complete the task comfortably and safely while seated. As expected, task performance significantly decreased under dual task conditions compared to single task conditions. We show that performance was significantly associated with cognitive impairment; significant differences were found among healthy participants, those with MCI, and those with ADRD. Task results were significantly associated with functional impairment, independent of diagnosis, degree of cognitive impairment (as indicated by the Mini Mental State Examination [MMSE] score), and age. Finally, we found that cognitive status could be classified with >70% accuracy using a range of classifier models trained on 3 different cognitive function outcome variables (consensus clinical judgment, Rey Auditory Verbal Learning Test [RAVLT], and MMSE). Conclusions: Our results suggest that the dual task ball balancing test could be used as a digital cognitive assessment of cognitive reserve. The portability, simplicity, and intuitiveness of the task suggest that it may be suitable for unsupervised home assessment of cognitive function. %M 39158963 %R 10.2196/49794 %U https://www.jmir.org/2024/1/e49794 %U https://doi.org/10.2196/49794 %U http://www.ncbi.nlm.nih.gov/pubmed/39158963 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55507 %T Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial %A Jimenez,Daniel E %A Ross,Emily J %A Weinstein,Elliott %A Gouse,Hetta %A Pan,Yue %A Martinez Garza,David %A Burke,Shanna L %A Joo,Jin Hui %A Behar-Zusman,Victoria %+ Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1436, Miami, FL, 33136, United States, 1 3052432776, dej18@miami.edu %K Latinos %K HIV %K AIDS %K cognitive decline %K health promotion %K intervention %K protocol %K single-arm %K pilot trial %K prevention %K older %K cognitive impairment %K impairment %K treatment %K dementia %K psychosocial %K men %K women %K cohort %D 2024 %7 12.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older Latino adults with HIV are at increased risk for mild cognitive impairment and earlier onset of aging-related cognitive decline. Improvements in cognitive functioning and cognitive outcomes are possible among people with HIV who adopt health promotion behaviors. However, health promotion interventions for older Latino adults with HIV have not been extensively used or widely recognized as viable treatment options. Happy Older Latinos are Active (HOLA) is a multicomponent, health promotion intervention that is uniquely tailored for older Latino adults with HIV. Objective: This study aims to (1) determine the feasibility and acceptability of an adapted version of HOLA aimed at improving cognitive functioning among older Latino adults with HIV; (2) explore whether HOLA will produce changes in cognitive functioning; (3) explore whether HOLA will produce changes in activity, psychosocial functioning, or biomarkers of cognition; and (4) explore whether changes in activity, psychosocial functioning or cognitive biomarkers correlate with changes in cognition, while accounting for genetic risk for dementia. Methods: A single-arm pilot trial with 30 Latino (aged 50 years and older) men and women with HIV was conducted to assess feasibility, acceptability, and preliminary effects on cognition. Participants were assessed at 2 time points (baseline and postintervention) on measures of neurocognitive and psychosocial functioning. In addition, blood samples were collected to determine biomarkers of cognition at baseline and postintervention. Successful recruitment was defined as meeting 100% of the targeted sample (N=30), with 20% (n=6) or less of eligible participants refusing to participate. Adequate retention was defined as 85% (n=25) or more of participants completing the postintervention assessment and acceptability was defined as 80% (n=38) or more of sessions attended by participants. Results: Participant recruitment began on February 22, 2022, and was completed on August 15, 2022. The last study visit took place on February 20, 2023. Data analysis is currently ongoing. Conclusions: Encouraging findings from this exploratory study may provide a blueprint for scaling up the HOLA intervention to a larger cohort of older Latino adults with HIV who may be currently experiencing or are at risk for HIV-related cognitive challenges. Trial Registration: ClinicalTrials.gov NCT04791709; https://clinicaltrials.gov/study/NCT04791709 International Registered Report Identifier (IRRID): DERR1-10.2196/55507 %M 39133532 %R 10.2196/55507 %U https://www.researchprotocols.org/2024/1/e55507 %U https://doi.org/10.2196/55507 %U http://www.ncbi.nlm.nih.gov/pubmed/39133532 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e56452 %T Examining the Relationships Between Indoor Environmental Quality Parameters Pertaining to Light, Noise, Temperature, and Humidity and the Behavioral and Psychological Symptoms of People Living With Dementia: Scoping Review %A Au-Yeung,Wan-Tai M %A Miller,Lyndsey %A Wu,Chao-Yi %A Beattie,Zachary %A Nunnerley,Michael %A Hanna,Remonda %A Gothard,Sarah %A Wild,Katherine %A Kaye,Jeffrey %+ Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 5034946695, auyeungm@ohsu.edu %K dementia %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K physical environment %K light %K noise %K temperature %K humidity %D 2024 %7 9.8.2024 %9 Review %J Interact J Med Res %G English %X Background: A common challenge for individuals caring for people with Alzheimer disease and related dementias is managing the behavioral and psychological symptoms of dementia (BPSD). Effective management of BPSD will increase the quality of life of people living with dementia, lessen caregivers’ burden, and lower health care cost. Objective: In this review, we seek to (1) examine how indoor environmental quality parameters pertaining to light, noise, temperature, and humidity are associated with BPSD and how controlling these parameters can help manage these symptoms and (2) identify the current state of knowledge in this area, current gaps in the research, and potential future directions. Methods: Searches were conducted in the CINAHL, Embase, MEDLINE, and PsycINFO databases for papers published from January 2007 to February 2024. We searched for studies examining the relationship between indoor environmental quality parameters pertaining to light, noise, temperature, and humidity and BPSD. Results: A total of 3123 papers were identified in the original search in October 2020. After an additional 2 searches and screening, 38 (0.69%) of the 5476 papers were included. Among the included papers, light was the most studied environmental factor (34/38, 89%), while there were fewer studies (from 5/38, 13% to 11/38, 29%) examining the relationships between other environmental factors and BPSD. Of the 38 studies, 8 (21%) examined multiple indoor environmental quality parameters. Subjective data were the only source of environmental assessments in 6 (16%) of the 38 studies. The findings regarding the relationship between agitation and light therapy are conflicted, while the studies that examined the relationship between BPSD and temperature or humidity are all observational. The results suggest that when the environmental factors are deemed overstimulating or understimulating for an individual with dementia, the behavioral symptoms tend to be exacerbated. Conclusions: The findings of this scoping review may inform the design of long-term care units and older adult housing to support aging in place. More research is still needed to better understand the relationship between indoor environmental quality parameters and BPSD, and there is a need for more objective measurements of both the indoor environmental quality parameters and behavioral symptoms. One future direction is to incorporate objective sensing and advanced computational methods in real-time assessments to initiate just-in-time environmental interventions. Better management of BPSD will benefit patients, caregivers, and the health care system. %M 39121471 %R 10.2196/56452 %U https://www.i-jmr.org/2024/1/e56452 %U https://doi.org/10.2196/56452 %U http://www.ncbi.nlm.nih.gov/pubmed/39121471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57830 %T Mapping Knowledge Landscapes and Emerging Trends in AI for Dementia Biomarkers: Bibliometric and Visualization Analysis %A Qi,Wenhao %A Zhu,Xiaohong %A He,Danni %A Wang,Bin %A Cao,Shihua %A Dong,Chaoqun %A Li,Yunhua %A Chen,Yanfei %A Wang,Bingsheng %A Shi,Yankai %A Jiang,Guowei %A Liu,Fang %A Boots,Lizzy M M %A Li,Jiaqi %A Lou,Xiajing %A Yao,Jiani %A Lu,Xiaodong %A Kang,Junling %+ School of Nursing, Hangzhou Normal University, No. 2318, Yuhangtang Road, Yuhang District, Hangzhou, 310021, China, 86 13777861361, csh@hznu.edu.cn %K artificial intelligence %K AI %K biomarker %K dementia %K machine learning %K bibliometric analysis %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rise of artificial intelligence (AI) in the field of dementia biomarker research, exploring its current developmental trends and research focuses has become increasingly important. This study, using literature data mining, analyzes and assesses the key contributions and development scale of AI in dementia biomarker research. Objective: The aim of this study was to comprehensively evaluate the current state, hot topics, and future trends of AI in dementia biomarker research globally. Methods: This study thoroughly analyzed the literature in the application of AI to dementia biomarkers across various dimensions, such as publication volume, authors, institutions, journals, and countries, based on the Web of Science Core Collection. In addition, scales, trends, and potential connections between AI and biomarkers were extracted and deeply analyzed through multiple expert panels. Results: To date, the field includes 1070 publications across 362 journals, involving 74 countries and 1793 major research institutions, with a total of 6455 researchers. Notably, 69.41% (994/1432) of the researchers ceased their studies before 2019. The most prevalent algorithms used are support vector machines, random forests, and neural networks. Current research frequently focuses on biomarkers such as imaging biomarkers, cerebrospinal fluid biomarkers, genetic biomarkers, and blood biomarkers. Recent advances have highlighted significant discoveries in biomarkers related to imaging, genetics, and blood, with growth in studies on digital and ophthalmic biomarkers. Conclusions: The field is currently in a phase of stable development, receiving widespread attention from numerous countries, institutions, and researchers worldwide. Despite this, stable clusters of collaborative research have yet to be established, and there is a pressing need to enhance interdisciplinary collaboration. Algorithm development has shown prominence, especially the application of support vector machines and neural networks in imaging studies. Looking forward, newly discovered biomarkers are expected to undergo further validation, and new types, such as digital biomarkers, will garner increased research interest and attention. %M 39116438 %R 10.2196/57830 %U https://www.jmir.org/2024/1/e57830 %U https://doi.org/10.2196/57830 %U http://www.ncbi.nlm.nih.gov/pubmed/39116438 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59705 %T Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial %A Attarha,Mouna %A de Figueiredo Pelegrino,Ana Carolina %A Toussaint,Paule-Joanne %A Grant,Sarah-Jane %A Van Vleet,Thomas %A de Villers-Sidani,Etienne %+ Posit Science Corporation, 160 Pine St Suite 200, San Francisco, CA, 94111, United States, 1 415 394 3100, mouna.attarha@positscience.com %K brain training %K cognitive training %K healthy aging %K neuroplasticity %K acetylcholine %K FEOBV %K randomized controlled trial %K aging %K ageing %K elderly %K elder %K older adults %K older adult %K neurological health %K cognitive %K computerized brain training %K computerize %K cognition %K cognitive decline %K Canada %D 2024 %7 8.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Our current understanding of how computerized brain training drives cognitive and functional benefits remains incomplete. This paper describes the protocol for Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE), a randomized controlled trial in healthy older adults designed to evaluate whether brain training improves cholinergic signaling. Objective: INHANCE evaluates whether 2 computerized training programs alter acetylcholine binding using the vesicular acetylcholine transporter ligand [18F] fluoroethoxybenzovesamicol ([18F] FEOBV) and positron emission tomography (PET). Methods: In this phase IIb, prospective, double-blind, parallel-arm, active-controlled randomized trial, a minimum of 92 community-dwelling healthy adults aged 65 years and older are randomly assigned to a brain training program designed using the principles of neuroplasticity (BrainHQ by Posit Science) or to an active control program of computer games designed for entertainment (eg, Solitaire). Both programs consist of 30-minute sessions, 7 times per week for 10 weeks (35 total hours), completed remotely at home using either loaned or personal devices. The primary outcome is the change in FEOBV binding in the anterior cingulate cortex, assessed at baseline and posttest. Exploratory cognitive and behavioral outcomes sensitive to acetylcholine are evaluated before, immediately after, and 3 months following the intervention to assess the maintenance of observed effects. Results: The trial was funded in September 2019. The study received approval from the Western Institutional Review Board in October 2020 with Research Ethics Board of McGill University Health Centre and Health Canada approvals in June 2021. The trial is currently ongoing. The first participant was enrolled in July 2021, enrollment closed when 93 participants were randomized in December 2023, and the trial will conclude in June 2024. The study team will be unblinded to conduct analyses after the final participant exits the study. We expect to publish the results in the fourth quarter of 2024. Conclusions: There remains a critical need to identify effective and scalable nonpharmaceutical interventions to enhance cognition in older adults. This trial contributes to our understanding of brain training by providing a potential neurochemical explanation of cognitive benefit. Trial Registration: ClinicalTrials.gov NCT04149457; https://clinicaltrials.gov/ct2/show/NCT04149457 International Registered Report Identifier (IRRID): DERR1-10.2196/59705 %M 39116435 %R 10.2196/59705 %U https://www.researchprotocols.org/2024/1/e59705 %U https://doi.org/10.2196/59705 %U http://www.ncbi.nlm.nih.gov/pubmed/39116435 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 3 %N %P e53038 %T Technology-Enabled Recreation and Leisure Programs and Activities for Older Adults With Cognitive Impairment: Rapid Scoping Review %A Kokorelias,Kristina Marie %A McMurray,Josephine %A Chu,Charlene %A Astell,Arlene %A Grigorovich,Alisa %A Kontos,Pia %A Babineau,Jessica %A Bytautas,Jessica %A Ahuja,Ashley %A Iaboni,Andrea %+ Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, 600 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 2899252096, kristina.kokorelias@sinaihealth.ca %K scoping review %K review methods %K review methodology %K knowledge synthesis %K synthesis %K syntheses %K scoping %K rapid review %K rapid reviews %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K gerontechnology %K technology %K recreation %K recreational %K leisure %K hobby %K hobbies %K cognitive %K MCI %K Alzheimer %K dementia %K digital health %D 2024 %7 8.8.2024 %9 Review %J JMIR Neurotech %G English %X Background: Recreational and leisure activities significantly contribute to the well-being of older adults, positively impacting physical, cognitive, and mental health. However, limited mobility and cognitive decline often impede access to these activities, particularly for individuals living with dementia. With the increasing availability of digital technologies, there is a rising interest in using technology to deliver recreation and leisure activities for cognitively impaired individuals, acknowledging its potential to provide diverse experiences. The COVID-19 pandemic further highlighted the need for virtual program delivery, especially for individuals in long-term care settings, leading to the development of tools like the Dementia Isolation Toolkit aimed at supporting compassionate isolation. To better support future implementations of the DIT, our rapid scoping review explores evidence-based, technology-enabled recreation programs for older adults with cognitive impairments, which promote well-being. Objective: We conducted a rapid scoping review of published peer-reviewed literature to answer the following research question: What recreation and leisure programs or activities are being delivered using technology to adults living with dementia or another form of cognitive impairment? Methods: In total, 6 databases were searched by an Information Specialist. Single reviewers performed title or abstract review, full-text screening, data extraction, and study characteristic summarization. Results: A total of 92 documents representing 94 studies were identified. The review identified a variety of technology-enabled delivery methods, including robots, gaming consoles, tablets, televisions, and computers, used to engage participants in recreational and leisure activities. These technologies impacted mood, cognition, functional activity, and overall well-being among older adults with cognitive impairments. Activities for socializing were the most common, leveraging technologies such as social robots and virtual companions, while relaxation methods used virtual reality and digital reminiscence therapy. However, challenges included technological complexity and potential distress during reminiscing activities, prompting recommendations for diversified research settings, and increased sample sizes to comprehensively understand technology's impact on leisure among this demographic. Conclusions: The findings suggest that technology-enabled recreational activities, such as socializing, relaxation and self-awareness activities, music and dance, exergaming, and art, can positively impact the mood and overall well-being of older adults with cognitive impairment. Future research should embrace a more inclusive approach, integrating design, diverse settings, and a broader sample of older adults to develop technology-driven leisure activities tailored to their unique needs and promote their effective use. %R 10.2196/53038 %U https://neuro.jmir.org/2024/1/e53038 %U https://doi.org/10.2196/53038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64127 %T Development and Evaluation of a Web-Based Platform for Personalized Educational and Professional Assistance for Dementia Caregivers: Proposal for a Mixed Methods Study %A DuBose,Logan %A Fan,Qiping %A Fisher,Louis %A Hoang,Minh-Nguyet %A Salha,Diana %A Lee,Shinduk %A Ory,Marcia G %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 201 Epsilon Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K Alzheimer disease %K dementia caregivers %K digital platform %K financial planning %K legal planning %K usability study %K evaluation %K older adults %K caregiver support %D 2024 %7 7.8.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Alzheimer disease (AD) and AD-related dementia are prevalent concerns for aging populations. With a growing older adult population living in the United States, the number of people living with dementia is expected to grow, posing significant challenges for informal caregivers. The mental and physical burdens associated with caregiving highlight the importance of developing novel and effective resources to support caregivers. However, technology solutions designed to address their needs often face low adoption rates due to usability issues and a lack of contextual relevance. This study focuses on developing a web-based platform providing financial and legal planning information and education for dementia caregivers and evaluating the platform’s usability and adoptability. Objective: The goal of this project is to create a web-based platform that connects caregivers with personalized and easily accessible resources. This project involves industrial, academic, and community partners and focuses on two primary aims: (1) developing a digital platform using a Dementia Care Personalization Algorithm and assessing feasibility in a pilot group of caregivers, and (2) evaluating the acceptability and usability of the digital platform across different racial or ethnic populations. This work will aid in the development of technology-based interventions to reduce caregiver burden. Methods: The phase I study follows an iterative Design Thinking approach, involving at least 25 dementia caregivers as a user feedback panel to assess the platform’s functionality, aesthetics, information, and overall quality using the adapted Mobile Application Rating Scale. Phase II is a usability study with 300 dementia caregivers in Texas (100 African American, 100 Hispanic or Latinx, and 100 non-Hispanic White). Participants will use the digital platform for about 4 weeks and evaluate its usefulness and ease of use through the Technology Acceptance Survey. Results: The study received funding from the National Institute on Aging on September 3, 2021. Ethical approval for phase I was obtained from the Texas A&M University Institutional Review Board on December 8, 2021, with data collection starting on January 1, 2022, and concluding on May 31, 2022. Phase I results were published on September 5, 2023, and April 17, 2024, respectively. On June 21, 2023, ethical approval for human subjects for phase II was granted, and participant recruitment began on July 1, 2023. Conclusions: Upon completing these aims, we expect to deliver a widely accessible digital platform tailored to assist dementia caregivers with financial and legal challenges by connecting them to personalized, contextually relevant information and resources in Texas. If successful, we plan to work with caregiving organizations to scale and sustain the platform, addressing the needs of the growing population living with dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/64127 %M 39110962 %R 10.2196/64127 %U https://www.researchprotocols.org/2024/1/e64127 %U https://doi.org/10.2196/64127 %U http://www.ncbi.nlm.nih.gov/pubmed/39110962 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52582 %T Markerless Motion Capture to Quantify Functional Performance in Neurodegeneration: Systematic Review %A Jeyasingh-Jacob,Julian %A Crook-Rumsey,Mark %A Shah,Harshvi %A Joseph,Theresita %A Abulikemu,Subati %A Daniels,Sarah %A Sharp,David J %A Haar,Shlomi %+ Department of Brain Sciences, Imperial College London, Sir Michael Uren Research Hub, London, W12 0BZ, United Kingdom, 44 20 759 48064, s.haar@imperial.ac.uk %K markerless motion capture %K motion analysis %K movement analysis %K motion %K neurodegeneration %K neurodegenerative %K systematic review %K movement %K body tracking %K tracking %K monitoring %K clinical decision making %K decision %K decision making %K dementia %K neurodegenerative disease %K mild cognitive impairment %K Parkinson's disease %K tool %K mobility %D 2024 %7 6.8.2024 %9 Review %J JMIR Aging %G English %X Background: Markerless motion capture (MMC) uses video cameras or depth sensors for full body tracking and presents a promising approach for objectively and unobtrusively monitoring functional performance within community settings, to aid clinical decision-making in neurodegenerative diseases such as dementia. Objective: The primary objective of this systematic review was to investigate the application of MMC using full-body tracking, to quantify functional performance in people with dementia, mild cognitive impairment, and Parkinson disease. Methods: A systematic search of the Embase, MEDLINE, CINAHL, and Scopus databases was conducted between November 2022 and February 2023, which yielded a total of 1595 results. The inclusion criteria were MMC and full-body tracking. A total of 157 studies were included for full-text screening, out of which 26 eligible studies that met the selection criteria were included in the review.  Results: Primarily, the selected studies focused on gait analysis (n=24), while other functional tasks, such as sit to stand (n=5) and stepping in place (n=1), were also explored. However, activities of daily living were not evaluated in any of the included studies. MMC models varied across the studies, encompassing depth cameras (n=18) versus standard video cameras (n=5) or mobile phone cameras (n=2) with postprocessing using deep learning models. However, only 6 studies conducted rigorous comparisons with established gold-standard motion capture models. Conclusions: Despite its potential as an effective tool for analyzing movement and posture in individuals with dementia, mild cognitive impairment, and Parkinson disease, further research is required to establish the clinical usefulness of MMC in quantifying mobility and functional performance in the real world. %R 10.2196/52582 %U https://aging.jmir.org/2024/1/e52582 %U https://doi.org/10.2196/52582 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57101 %T Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study %A Imai,Ayu %A Matsuoka,Teruyuki %A Nakayama,Chikara %A Hashimoto,Nana %A Sano,Mutsuo %A Narumoto,Jin %+ Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan, 81 075 251 5612, tmms2004@koto.kpu-m.ac.jp %K loneliness %K virtual reality %K VR %K Alzheimer disease %K predementia %K intervention %K subjective cognitive decline %K mild cognitive impairment %K dementia %K older adult %K geriatric %K depression %K cognitive impairments %D 2024 %7 1.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. Objective: This study aims to assess the impact of a virtual reality (VR)–based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. Methods: The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. Results: Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. Conclusions: This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR’s impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. Trial Registration: University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5 International Registered Report Identifier (IRRID): DERR1-10.2196/57101 %M 39088243 %R 10.2196/57101 %U https://www.researchprotocols.org/2024/1/e57101 %U https://doi.org/10.2196/57101 %U http://www.ncbi.nlm.nih.gov/pubmed/39088243 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55961 %T Making Co-Design More Responsible: Case Study on the Development of an AI-Based Decision Support System in Dementia Care %A Lukkien,Dirk R M %A Ipakchian Askari,Sima %A Stolwijk,Nathalie E %A Hofstede,Bob M %A Nap,Henk Herman %A Boon,Wouter P C %A Peine,Alexander %A Moors,Ellen H M %A Minkman,Mirella M N %+ Vilans Centre of Expertise of Long Term Care, Churchilllaan 11, Utrecht, 3505 RE, Netherlands, 31 612416513, d.lukkien@vilans.nl %K responsible innovation %K co-design %K ethics %K decision support systems %K gerontechnology %K dementia %K long-term care %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Emerging technologies such as artificial intelligence (AI) require an early-stage assessment of potential societal and ethical implications to increase their acceptability, desirability, and sustainability. This paper explores and compares 2 of these assessment approaches: the responsible innovation (RI) framework originating from technology studies and the co-design approach originating from design studies. While the RI framework has been introduced to guide early-stage technology assessment through anticipation, inclusion, reflexivity, and responsiveness, co-design is a commonly accepted approach in the development of technologies to support the care for older adults with frailty. However, there is limited understanding about how co-design contributes to the anticipation of implications. Objective: This paper empirically explores how the co-design process of an AI-based decision support system (DSS) for dementia caregivers is complemented by explicit anticipation of implications. Methods: This case study investigated an international collaborative project that focused on the co-design, development, testing, and commercialization of a DSS that is intended to provide actionable information to formal caregivers of people with dementia. In parallel to the co-design process, an RI exploration took place, which involved examining project members’ viewpoints on both positive and negative implications of using the DSS, along with strategies to address these implications. Results from the co-design process and RI exploration were analyzed and compared. In addition, retrospective interviews were held with project members to reflect on the co-design process and RI exploration. Results: Our results indicate that, when involved in exploring requirements for the DSS, co-design participants naturally raised various implications and conditions for responsible design and deployment: protecting privacy, preventing cognitive overload, providing transparency, empowering caregivers to be in control, safeguarding accuracy, and training users. However, when comparing the co-design results with insights from the RI exploration, we found limitations to the co-design results, for instance, regarding the specification, interrelatedness, and context dependency of implications and strategies to address implications. Conclusions: This case study shows that a co-design process that focuses on opportunities for innovation rather than balancing attention for both positive and negative implications may result in knowledge gaps related to social and ethical implications and how they can be addressed. In the pursuit of responsible outcomes, co-design facilitators could broaden their scope and reconsider the specific implementation of the process-oriented RI principles of anticipation and inclusion. %M 39083768 %R 10.2196/55961 %U https://humanfactors.jmir.org/2024/1/e55961 %U https://doi.org/10.2196/55961 %U http://www.ncbi.nlm.nih.gov/pubmed/39083768 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55785 %T Effects of Electronic Serious Games on Older Adults With Alzheimer’s Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials %A Zuo,Xinyi %A Tang,Yong %A Chen,Yifang %A Zhou,Zhimiao %+ Sociology Department, School of Government, Shenzhen University, 1066 Xueyuan Avenue, Nanshan District, Shenzhen, Guangdong, 518055, China, 86 13670191924, tangyong@szu.edu.cn %K digital serious games %K cognitive ability %K daily behavioral capacity %K mental health %K depression %K older adults with AD and MCI %K AD %K Alzheimer’s disease %K MD %K mild cognitive impairment %K systematic review %K meta-analysis %D 2024 %7 31.7.2024 %9 Review %J JMIR Serious Games %G English %X Background: Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer’s disease (AD) and mild cognitive impairment (MCI). Objective: This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies. Methods: This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed. Results: From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD –2.08, 95% CI –2.94 to –1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests. Conclusions: Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090 %R 10.2196/55785 %U https://games.jmir.org/2024/1/e55785 %U https://doi.org/10.2196/55785 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54032 %T Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study %A Engelsma,Thomas %A Heijmink,Simone %A Hendriksen,Heleen M A %A Visser,Leonie N C %A Lemstra,Afina W %A Jaspers,Monique W M %A Peute,Linda W P %+ eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 657570009, t.engelsma@amsterdamumc.nl %K dementia %K design principles %K digital health %K memory clinic %K usability evaluation %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user’s expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. %M 39083790 %R 10.2196/54032 %U https://humanfactors.jmir.org/2024/1/e54032 %U https://doi.org/10.2196/54032 %U http://www.ncbi.nlm.nih.gov/pubmed/39083790 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56433 %T The Best of Two Worlds to Promote Healthy Cognitive Aging: Definition and Classification Approach of Hybrid Physical Training Interventions %A Herold,Fabian %A Theobald,Paula %A Gronwald,Thomas %A Kaushal,Navin %A Zou,Liye %A de Bruin,Eling D %A Bherer,Louis %A Müller,Notger G %+ Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, Potsdam, 14476, Germany, 49 0331977213858, fabian.herold@uni-potsdam.de %K physical activity %K dementia prevention %K cognitive health %K hybrid: aging in place %K active %K exercises %K exercising %K healthy lifestyle %K dementia %K dementia onset %K dementia care %K preventive %K prevention %K cognitive health %K cognition %K cognitive %K hybrid %K hybrid model %D 2024 %7 31.7.2024 %9 Viewpoint %J JMIR Aging %G English %X A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas. %M 39083334 %R 10.2196/56433 %U https://aging.jmir.org/2024/1/e56433 %U https://doi.org/10.2196/56433 %U http://www.ncbi.nlm.nih.gov/pubmed/39083334 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60009 %T Correlates of Mild Behavioral Impairment in Older Adults: Protocol for a Scoping Review %A Yoon,Seolah %A Jeong,Innhee %A Kim,Jennifer Ivy %A Hong,Dahye %A Kang,Bada %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea, 82 02 2228 3283, bdkang@yuhs.ac %K mild behavioral impairment %K older adults %K mild cognitive impairment %K subjective cognitive decline %K behavioral symptoms %K scoping review %K protocol %K elderly %K behavioral impairment %K cognitive %K cognitive decline %K scoping review protocol %K older adult %K neuropsychological %K impairment %K behavioral %K behavior %D 2024 %7 29.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Understanding mild behavioral impairment, a relatively recent notion in neuropsychological studies, provides significant insights into early behavioral indicators of cognitive decline and predicts the onset of dementia in older adults. Although the importance of understanding mild behavioral impairment is acknowledged, comprehensive reviews of its correlates with older adults are limited. Objective: This scoping review aims to identify the impact of mild behavioral impairment on health outcomes in older adults and the factors associated with mild behavioral impairment. Methods: The review will adhere to the Joanna Briggs Institute’s methodological principles for scoping reviews. We will include studies focusing mainly on mild behavioral impairment in older adults, with the literature on this topic being limited to the period from 2003 to the present. Other clinical diagnoses, such as cognitive impairment, Parkinson disease, and multiple sclerosis, will not be included. We will use databases including PubMed (MEDLINE), CINAHL, Web of Science, Embase, PsycINFO, Cochrane, and Scopus for relevant articles published in English. Both gray literature and peer-reviewed articles will be considered during screening. Three independent reviewers will extract data using a predefined data extraction tool. Extracted data will be presented using tables, figures, and a narrative summary aligned with review questions, accompanied by an analysis of study characteristics and categorization of mild behavioral impairment correlates. Results: The results will be presented as a descriptive summary, structured according to the associated factors related to mild behavioral impairment, and the health outcomes. Additionally, the data on study characteristics will be presented in tabular format. An exploratory search was conducted in July 2023 to establish a comprehensive search strategy, and iterative refinements to the scoping review protocol and formalization of methods were completed. A follow-up search is planned for May 2024, with the aim of submitting the findings for publication in peer-reviewed journals. Conclusions: To our knowledge, this would be the first study to map the literature on the health-related factors and outcomes of mild behavioral impairment. The findings will support the development of interventions to prevent the occurrence of mild behavioral impairment and mitigate the negative outcomes of mild behavioral impairment. International Registered Report Identifier (IRRID): DERR1-10.2196/60009 %M 39074360 %R 10.2196/60009 %U https://www.researchprotocols.org/2024/1/e60009 %U https://doi.org/10.2196/60009 %U http://www.ncbi.nlm.nih.gov/pubmed/39074360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45780 %T Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study %A Akhter-Khan,Samia C %A Tao,Qiushan %A Ang,Ting Fang Alvin %A Karjadi,Cody %A Itchapurapu,Indira Swetha %A Libon,David J %A Alosco,Michael %A Mez,Jesse %A Qiu,Wei Qiao %A Au,Rhoda %+ Framingham Heart Study, Boston University School of Medicine, 72 East Concord Street, R-623D, Boston, MA, 02118, United States, 1 6176384336, wqiu67@bu.edu %K cerebral microbleeds %K CMB %K digital clock-drawing test %K DCT %K Alzheimer disease %K dementia %K early screening %K Boston Process Approach %K cerebral microbleed %K neuroimaging %K cerebrovascular diseases %K aging %K MRI %K magnetic resonance imaging %K clock-drawing test %K cognitive function %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. Objective: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. Methods: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. Results: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=–0.65, 95% CI –1.15 to –0.15; P=.01) and simple motor (β=–0.86, 95% CI –1.43 to –0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. Conclusions: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral. %M 39073857 %R 10.2196/45780 %U https://www.jmir.org/2024/1/e45780 %U https://doi.org/10.2196/45780 %U http://www.ncbi.nlm.nih.gov/pubmed/39073857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51400 %T Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis %A Myers,Jennifer Rae %A Bryk,Kelsey N %A Madero,Erica N %A McFarlane,Jacob %A Campitelli,Anthony %A Gills,Joshua %A Jones,Megan %A Paulson,Sally %A Gray,Michelle %A Glenn,Jordan M %+ Neurotrack Technologies, 399 Bradford St #101, Redwood City, CA, 94063, United States, 1 6505498566, jennifer.r.myers@outlook.com %K Alzheimer disease %K cognition %K intervention %K rural issues %K digital health %K geriatric %K geriatrics %K elder %K elderly %K diabetes %K diabetes mellitus %K dementia %K digital cognitive health coaching %K rural %K countryside %K qualitative study %K thematic analysis %K mHealth %K telehealth %K health informatics %K mental health %K behavioral change %K healthy lifestyle %K coach support %K self-awareness %K prevention %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. Objective: The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. Methods: This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant’s goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, “What were your top 1 or 2 takeaways from your recent Health Coaching session?” and “Is there anything you would change about our Health Coaching sessions?” A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). Results: The following four themes emerged from participants’ feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Conclusions: Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): RR2-10.2196/31841 %M 39038282 %R 10.2196/51400 %U https://formative.jmir.org/2024/1/e51400 %U https://doi.org/10.2196/51400 %U http://www.ncbi.nlm.nih.gov/pubmed/39038282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51943 %T Algorithmic Spaced Retrieval Enhances Long-Term Memory in Alzheimer Disease: Case-Control Pilot Study %A Smith,Amy M %A Marin,Anna %A DeCaro,Renee E %A Feinn,Richard %A Wack,Audrey %A Hughes,Gregory I %A Rivard,Nathaniel %A Umashankar,Akshay %A Turk,Katherine W %A Budson,Andrew E %+ Blank Slate Technologies, LLC, 4075 Wilson Blvd, Arlington, VA, 22203, United States, 1 2034018923, smitham192@gmail.com %K Alzheimer disease %K spaced retrieval %K mobile app %K assistive technology %K episodic memory %K semantic memory %K mobile phone %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Spaced retrieval is a learning technique that involves engaging in repeated memory testing after increasingly lengthy intervals of time. Spaced retrieval has been shown to improve long-term memory in Alzheimer disease (AD), but it has historically been difficult to implement in the everyday lives of individuals with AD. Objective: This research aims to determine, in people with mild cognitive impairment (MCI) due to AD, the efficacy and feasibility of a mobile app that combines spaced retrieval with a machine learning algorithm to enhance memory retention. Specifically, the app prompts users to answer questions during brief daily sessions, and a machine learning algorithm tracks each user’s rate of forgetting to determine the optimal spacing schedule to prevent anticipated forgetting. Methods: In this pilot study, 61 participants (young adults: n=21, 34%; healthy older adults: n=20, 33%; people with MCI due to AD: n=20, 33%) used the app for 4 weeks to learn new facts and relearn forgotten name-face associations. Participation during the 4-week period was characterized by using the app once per day to answer 15 questions about the facts and names. After the 4-week learning phase, participants completed 2 recognition memory tests approximately 1 week apart, which tested memory for information they had studied using the app as well as information they had not studied. Results: After using the mobile app for 1 month, every person with MCI due to AD demonstrated improvements in memory for new facts that they had studied via the app compared to baseline (P<.001). All but one person with MCI due to AD (19/20, 95%) showed improvements of more than 10 percentage points, comparable to the improvements shown by young adults and healthy older adults. Memory for name-face associations was similarly improved for all participant groups after using the app but to a lesser degree. Furthermore, for both new facts and name-face associations, we found no memory decay for any participant group after they took a break of approximately 1 week from using the app at the end of the study. Regarding usability, of the 20 people with MCI due to AD, 16 (80%) self-adhered to the app’s automated practice schedule, and half of them (n=10, 50%) expressed an interest in continuing to use it. Conclusions: These results demonstrate early evidence that spaced retrieval mobile apps are both feasible for people with early-stage AD to use in their everyday lives and effective for supporting memory retention of recently learned facts and name-face associations. %M 39028554 %R 10.2196/51943 %U https://formative.jmir.org/2024/1/e51943 %U https://doi.org/10.2196/51943 %U http://www.ncbi.nlm.nih.gov/pubmed/39028554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55575 %T Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers %A Xu,Qidi %A Kim,Yejin %A Chung,Karen %A Schulz,Paul %A Gottlieb,Assaf %+ McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 7135003698, assaf.gottlieb@uth.tmc.edu %K mild cognitive impairment %K Fitbits %K fitness trackers %K sleep %K physical activity %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI). Objective: This study aimed to use data collected from fitness trackers to predict MCI status. Methods: In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status. Results: Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time. Conclusions: Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies. %M 39024003 %R 10.2196/55575 %U https://formative.jmir.org/2024/1/e55575 %U https://doi.org/10.2196/55575 %U http://www.ncbi.nlm.nih.gov/pubmed/39024003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59546 %T Twitter Discussions on #digitaldementia: Content and Sentiment Analysis %A Cho,Hyeongchan %A Kim,Kyu-Min %A Kim,Jee-Young %A Youn,Bo-Young %+ Department of Bio-Healthcare, Hwasung Medi-Science University, A-311, 400-5, Namyangjungang-ro, Namyang-eup, Hwaseong-si, Gyeonggi-do, 18274, Republic of Korea, 82 31 369 9116, jamesyoun@hsmu.ac.kr %K digital dementia %K dementia %K public health %K Twitter %K social media %K mobile phone %D 2024 %7 16.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital dementia is a term that describes a possible decline in cognitive abilities, especially memory, attributed to the excessive use of digital technology such as smartphones, computers, and tablets. This concept has gained popularity in public discourse and media lately. With the increasing use of social media platforms such as Twitter (subsequently rebranded as X), discussions about digital dementia have become more widespread, which offer a rich source of information to understand public perceptions, concerns, and sentiments regarding this phenomenon. Objective: The aim of this research was to delve into a comprehensive content and sentiment analysis of Twitter discussions regarding digital dementia using the hashtag #digitaldementia. Methods: Retrospectively, publicly available English-language tweets with hashtag combinations related to the topic of digital dementia were extracted from Twitter. The tweets were collected over a period of 15 years, from January 1, 2008, to December 31, 2022. Content analysis was used to identify major themes within the tweets, and sentiment analysis was conducted to understand the positive and negative emotions associated with these themes in order to gain a better understanding of the issues surrounding digital dementia. A one-way ANOVA was performed to gather detailed statistical insights regarding the selected tweets from influencers within each theme. Results: This study was conducted on 26,290 tweets over 15 years by 5123 Twitter users, mostly female users in the United States. The influencers had followers ranging from 20,000 to 1,195,000 and an average of 214,878 subscribers. The study identified four themes regarding digital dementia after analyzing tweet content: (1) cognitive decline, (2) digital dependency, (3) technology overload, and (4) coping strategies. Categorized according to Glaser and Strauss’s classifications, most tweets (14,492/26,290, 55.12%) fell under the categories of wretched (purely negative) or bad (mostly negative). However, only a small proportion of tweets (3122/26,290, 11.86%) were classified as great (purely positive) or swell sentiment (mostly positive). The ANOVA results showed significant differences in mean sentiment scores among the themes (F3,3581=29.03; P<.001). The mean sentiment score was –0.1072 (SD 0.4276). Conclusions: Various negative tweets have raised concerns about the link between excessive use of digital devices and cognitive decline, often known as digital dementia. Of particular concern is the rapid increase in digital device use. However, some positive tweets have suggested coping strategies. Engaging in digital detox activities, such as increasing physical exercise and participating in yoga and meditation, could potentially help prevent cognitive decline. %M 39012679 %R 10.2196/59546 %U https://www.jmir.org/2024/1/e59546 %U https://doi.org/10.2196/59546 %U http://www.ncbi.nlm.nih.gov/pubmed/39012679 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56608 %T Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial %A Miura,Kumi Watanabe %A Kudo,Takashi %A Otake-Matsuura,Mihoko %+ Center for Advanced Intelligence Project, RIKEN, Nihonbashi 1-chome Mitsui Building, 15th floor 1-4-1 Nihonbashi, Tokyo, 103-0027, Japan, 81 3 6225 2482, mihoko.otake@riken.jp %K randomized controlled trial %K web-based intervention %K communication technology %K cognitive health %K neural blood markers %K social isolation %K well-being %D 2024 %7 11.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. Objective: This study will examine the effects of “Photo-Integrated Conversation Moderated by Application version 2” (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. Methods: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. Results: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. Conclusions: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. Trial Registration: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66 International Registered Report Identifier (IRRID): DERR1-10.2196/56608 %M 38990615 %R 10.2196/56608 %U https://www.researchprotocols.org/2024/1/e56608 %U https://doi.org/10.2196/56608 %U http://www.ncbi.nlm.nih.gov/pubmed/38990615 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51520 %T Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study %A Teano,Anthony L %A Scott,Ashley %A Gipson,Cassandra %A Albert,Marilyn %A Pettigrew,Corinne %+ Department of Neurology, Johns Hopkins University School of Medicine, 550 N. Broadway St., Suite 415, Baltimore, MD, 21205, United States, 1 410 614 0363, cpettigrew@jhmi.edu %K education %K social media %K outreach %K recruitment %K Alzheimer’s disease %K Alzheimer disease %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media–based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center’s social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform’s native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P≤.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. %M 38981112 %R 10.2196/51520 %U https://aging.jmir.org/2024/1/e51520 %U https://doi.org/10.2196/51520 %U http://www.ncbi.nlm.nih.gov/pubmed/38981112 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54748 %T Self-Explainable Graph Neural Network for Alzheimer Disease and Related Dementias Risk Prediction: Algorithm Development and Validation Study %A Hu,Xinyue %A Sun,Zenan %A Nian,Yi %A Wang,Yichen %A Dang,Yifang %A Li,Fang %A Feng,Jingna %A Yu,Evan %A Tao,Cui %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, United States, 1 904 956 3256, tao.cui@mayo.edu %K Alzheimer disease and related dementias %K risk prediction %K graph neural network %K relation importance %K machine learning %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (ADRD) rank as the sixth leading cause of death in the United States, underlining the importance of accurate ADRD risk prediction. While recent advancements in ADRD risk prediction have primarily relied on imaging analysis, not all patients undergo medical imaging before an ADRD diagnosis. Merging machine learning with claims data can reveal additional risk factors and uncover interconnections among diverse medical codes. Objective: The study aims to use graph neural networks (GNNs) with claim data for ADRD risk prediction. Addressing the lack of human-interpretable reasons behind these predictions, we introduce an innovative, self-explainable method to evaluate relationship importance and its influence on ADRD risk prediction. Methods: We used a variationally regularized encoder-decoder GNN (variational GNN [VGNN]) integrated with our proposed relation importance method for estimating ADRD likelihood. This self-explainable method can provide a feature-important explanation in the context of ADRD risk prediction, leveraging relational information within a graph. Three scenarios with 1-year, 2-year, and 3-year prediction windows were created to assess the model’s efficiency, respectively. Random forest (RF) and light gradient boost machine (LGBM) were used as baselines. By using this method, we further clarify the key relationships for ADRD risk prediction. Results: In scenario 1, the VGNN model showed area under the receiver operating characteristic (AUROC) scores of 0.7272 and 0.7480 for the small subset and the matched cohort data set. It outperforms RF and LGBM by 10.6% and 9.1%, respectively, on average. In scenario 2, it achieved AUROC scores of 0.7125 and 0.7281, surpassing the other models by 10.5% and 8.9%, respectively. Similarly, in scenario 3, AUROC scores of 0.7001 and 0.7187 were obtained, exceeding 10.1% and 8.5% than the baseline models, respectively. These results clearly demonstrate the significant superiority of the graph-based approach over the tree-based models (RF and LGBM) in predicting ADRD. Furthermore, the integration of the VGNN model and our relation importance interpretation could provide valuable insight into paired factors that may contribute to or delay ADRD progression. Conclusions: Using our innovative self-explainable method with claims data enhances ADRD risk prediction and provides insights into the impact of interconnected medical code relationships. This methodology not only enables ADRD risk modeling but also shows potential for other image analysis predictions using claims data. %M 38976869 %R 10.2196/54748 %U https://aging.jmir.org/2024/1/e54748 %U https://doi.org/10.2196/54748 %U http://www.ncbi.nlm.nih.gov/pubmed/38976869 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e47565 %T Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study %A Ansaldo,Ana Inés %A Masson-Trottier,Michèle %A Delacourt,Barbara %A Dubuc,Jade %A Dubé,Catherine %+ Laboratoire de Plasticité cérébrale, Communication et Vieillissement, Centre de recherche de l'Institut Universitaire de gériatrie de Montréal, Université de Montréal, 4565 Queen Mary Road, Montréal, QC, H3W1W5, Canada, 1 5143403540 ext 3933, ana.ines.ansaldo@umontreal.ca %K dementia %K communication %K caregivers %K technology %K burden %K mixed methods design %K quality of life %K mobile phone %K tablet %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. Objective: This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. Methods: In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Results: Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]). Conclusions: COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions. %M 38963691 %R 10.2196/47565 %U https://aging.jmir.org/2024/1/e47565 %U https://doi.org/10.2196/47565 %U http://www.ncbi.nlm.nih.gov/pubmed/38963691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50186 %T mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan %A Ali,Suad %A Alizai,Hira %A Hagos,Delal Jemal %A Rubio,Sindy Ramos %A Calabia,Dale %A Serrano Jimenez,Penelope %A Senthil,Vinuu Aarif %A Appel,Lora %+ Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, lora.appel@yorku.ca %K dementia %K Alzheimer disease %K mHealth %K mobile health %K apps %K lifestyle behaviors %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. Objective: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. Methods: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Results: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. Conclusions: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully. %M 38959029 %R 10.2196/50186 %U https://mhealth.jmir.org/2024/1/e50186 %U https://doi.org/10.2196/50186 %U http://www.ncbi.nlm.nih.gov/pubmed/38959029 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51987 %T Technology Usability for People Living With Dementia: Concept Analysis %A Chien,Shao-Yun %A Zaslavsky,Oleg %A Berridge,Clara %+ School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2068493301, ozasl@uw.edu %K usability %K dementia %K older adults %K technology %K concept analysis %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Usability is a key indicator of the quality of technology products. In tandem with technological advancements, potential use by individuals with dementia is increasing. However, defining the usability of technology for individuals with dementia remains an ongoing challenge. The diverse and progressive nature of dementia adds complexity to the creation of universal usability criteria, highlighting the need for focused deliberations. Technological interventions offer potential benefits for people living with dementia and caregivers. Amid COVID-19, technology’s role in health care access is growing, especially among older adults. Enabling the diverse population of people living with dementia to enjoy the benefits of technologies requires particular attention to their needs, desires, capabilities, and vulnerabilities to potential harm from technologies. Successful technological interventions for dementia require meticulous consideration of technology usability. Objective: This concept analysis aims to examine the usability of technology in the context of individuals living with dementia to establish a clear definition for usability within this specific demographic. Methods: The framework by Walker and Avant was used to guide this concept analysis. We conducted a literature review spanning 1984 to 2024, exploring technology usability for people with dementia through the PubMed, Web of Science, and Google Scholar databases using the keywords “technology usability” and “dementia.” We also incorporated clinical definitions and integrated interview data from 29 dyads comprising individuals with mild Alzheimer dementia and their respective care partners, resulting in a total of 58 older adults. This approach aimed to offer a more comprehensive portrayal of the usability needs of individuals living with dementia, emphasizing practical application. Results: The evidence from the literature review unveiled that usability encompasses attributes such as acceptable learnability, efficiency, and satisfaction. The clinical perspective on dementia stages, subtypes, and symptoms underscores the importance of tailored technology usability assessment. Feedback from 29 dyads also emphasized the value of simplicity, clear navigation, age-sensitive design, personalized features, and audio support. Thus, design should prioritize personalized assistance for individuals living with dementia, moving away from standardized technological approaches. Synthesized from various sources, the defined usability attributes for individuals living with dementia not only encompass the general usability properties of effectiveness, efficiency, and satisfaction but also include other key factors: adaptability, personalization, intuitiveness, and simplicity, to ensure that technology is supportive and yields tangible benefits for this demographic. Conclusions: Usability is crucial for people living with dementia when designing technological interventions. It necessitates an understanding of user characteristics, dementia stages, symptoms, needs, and tasks, as well as consideration of varied physical requirements, potential sensory loss, and age-related changes. Disease progression requires adapting to evolving symptoms. Recommendations include versatile, multifunctional technology designs; accommodating diverse needs; and adjusting software functionalities for personalization. Product feature classification can be flexible based on user conditions. %M 38959053 %R 10.2196/51987 %U https://aging.jmir.org/2024/1/e51987 %U https://doi.org/10.2196/51987 %U http://www.ncbi.nlm.nih.gov/pubmed/38959053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58501 %T Improving the Acceptability and Implementation of Information and Communication Technology–Based Health Care Platforms for Older People With Dementia or Parkinson Disease: Qualitative Study Results of Key Stakeholders %A Ahmed,Mona %A Marín,Mayca %A Gangas,Pilar %A Bentlage,Ellen %A Louro,Claudia %A Brach,Michael %+ Institute of Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 8334812, mona.ahmad@uni-muenster.de %K acceptability %K implementation %K neurodegenerative diseases %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K older people %K stakeholders %K information and communication technology %K ICT %K user-centered design %K co-design %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The management of neurodegenerative diseases (NDDs) in older populations is usually demanding and involves care provision by various health care services, resulting in a greater burden on health care systems in terms of costs and resources. The convergence of various health services within integrated health care models, which are enabled and adopted jointly with information and communication technologies (ICTs), has been identified as an effective alternative health care solution. However, its widespread implementation faces formidable challenges. Both the development and implementation of integrated ICTs are linked to the collaboration and acceptance of different groups of stakeholders beyond patients and health care professionals, with reported discrepancies in the needs and preferences among these groups. Objective: Complementing a previous publication, which reported on the needs and requirements of end users in the development of the European Union–funded project PROCare4Life (Personalized Integrated Care Promoting Quality of Life for Older People), this paper aimed to report on the opinions of other key stakeholders from various fields, including academia, media, market, and decision making, for improving the acceptability and implementation of an integrated ICT-based health care platform supporting the management of NDDs. Methods: The study included 30 individual semistructured interviews that took place between June and August 2020 in 5 European countries (Germany, Italy, Portugal, Romania, and Spain). Interviews were mostly conducted online, except in cases where participants requested to be interviewed in person. In these cases, COVID-19 PROCare4Life safety procedures were applied. Results: This study identified 2 themes and 5 subthemes. User engagement, providing training and education, and the role played by the media were identified as strategic measures to ensure the acceptability of ICT-based health care platforms. Sustainable funding and cooperation with authorities were foreseen as additional points to be considered in the implementation process. Conclusions: The importance of the user-centered design approach in ensuring the involvement of users in the development of ICT-based platforms has been highlighted. The most common challenges that hinder the acceptability and implementation of ICT-based health care platforms can be addressed by creating synergies among the efforts of users, academic stakeholders, developers, policy makers, and decision makers. To support future projects in developing ICT-based health care platforms, this study outlined the following recommendations that can be integrated when conducting research on users’ needs: (1) properly identify the particular challenges faced by future user groups without neglecting their social and clinical contexts; (2) iteratively assess the digital skills of future users and their acceptance of the proposed platform; (3) align the functionalities of the ICT platform with the real needs of future users; and (4) involve key stakeholders to guide the reflection on how to implement the platform in the future. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 38935424 %R 10.2196/58501 %U https://formative.jmir.org/2024/1/e58501 %U https://doi.org/10.2196/58501 %U http://www.ncbi.nlm.nih.gov/pubmed/38935424 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48777 %T Detection of Mild Cognitive Impairment Through Hand Motor Function Under Digital Cognitive Test: Mixed Methods Study %A Li,Aoyu %A Li,Jingwen %A Chai,Jiali %A Wu,Wei %A Chaudhary,Suamn %A Zhao,Juanjuan %A Qiang,Yan %+ College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, No. 209, University Street, Yuji District, Shanxi Province, Jinzhong, 030024, China, 86 18635168680, qiangyan@tyut.edu.cn %K mild cognitive impairment %K movement kinetics %K digital cognitive test %K dual task %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early detection of cognitive impairment or dementia is essential to reduce the incidence of severe neurodegenerative diseases. However, currently available diagnostic tools for detecting mild cognitive impairment (MCI) or dementia are time-consuming, expensive, or not widely accessible. Hence, exploring more effective methods to assist clinicians in detecting MCI is necessary. Objective: In this study, we aimed to explore the feasibility and efficiency of assessing MCI through movement kinetics under tablet-based “drawing and dragging” tasks. Methods: We iteratively designed “drawing and dragging” tasks by conducting symposiums, programming, and interviews with stakeholders (neurologists, nurses, engineers, patients with MCI, healthy older adults, and caregivers). Subsequently, stroke patterns and movement kinetics were evaluated in healthy control and MCI groups by comparing 5 categories of features related to hand motor function (ie, time, stroke, frequency, score, and sequence). Finally, user experience with the overall cognitive screening system was investigated using structured questionnaires and unstructured interviews, and their suggestions were recorded. Results: The “drawing and dragging” tasks can detect MCI effectively, with an average accuracy of 85% (SD 2%). Using statistical comparison of movement kinetics, we discovered that the time- and score-based features are the most effective among all the features. Specifically, compared with the healthy control group, the MCI group showed a significant increase in the time they took for the hand to switch from one stroke to the next, with longer drawing times, slow dragging, and lower scores. In addition, patients with MCI had poorer decision-making strategies and visual perception of drawing sequence features, as evidenced by adding auxiliary information and losing more local details in the drawing. Feedback from user experience indicates that our system is user-friendly and facilitates screening for deficits in self-perception. Conclusions: The tablet-based MCI detection system quantitatively assesses hand motor function in older adults and further elucidates the cognitive and behavioral decline phenomenon in patients with MCI. This innovative approach serves to identify and measure digital biomarkers associated with MCI or Alzheimer dementia, enabling the monitoring of changes in patients’ executive function and visual perceptual abilities as the disease advances. %M 38924786 %R 10.2196/48777 %U https://mhealth.jmir.org/2024/1/e48777 %U https://doi.org/10.2196/48777 %U http://www.ncbi.nlm.nih.gov/pubmed/38924786 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e52831 %T Examining Associations Between Smartphone Use and Clinical Severity in Frontotemporal Dementia: Proof-of-Concept Study %A Paolillo,Emily W %A Casaletto,Kaitlin B %A Clark,Annie L %A Taylor,Jack C %A Heuer,Hilary W %A Wise,Amy B %A Dhanam,Sreya %A Sanderson-Cimino,Mark %A Saloner,Rowan %A Kramer,Joel H %A Kornak,John %A Kremers,Walter %A Forsberg,Leah %A Appleby,Brian %A Bayram,Ece %A Bozoki,Andrea %A Brushaber,Danielle %A Darby,R Ryan %A Day,Gregory S %A Dickerson,Bradford C %A Domoto-Reilly,Kimiko %A Elahi,Fanny %A Fields,Julie A %A Ghoshal,Nupur %A Graff-Radford,Neill %A G H Hall,Matthew %A Honig,Lawrence S %A Huey,Edward D %A Lapid,Maria I %A Litvan,Irene %A Mackenzie,Ian R %A Masdeu,Joseph C %A Mendez,Mario F %A Mester,Carly %A Miyagawa,Toji %A Naasan,Georges %A Pascual,Belen %A Pressman,Peter %A Ramos,Eliana Marisa %A Rankin,Katherine P %A Rexach,Jessica %A Rojas,Julio C %A VandeVrede,Lawren %A Wong,Bonnie %A Wszolek,Zbigniew K %A Boeve,Bradley F %A Rosen,Howard J %A Boxer,Adam L %A Staffaroni,Adam M %A , %+ Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 19094158, San Francisco, CA, 94158, United States, 1 3476615999, emily.paolillo@ucsf.edu %K digital %K technology %K remote %K monitoring %K cognition %K neuropsychology %K cognitive impairment %K neurodegenerative %K screening %K clinical trials %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown. Objective: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD. Methods: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer’s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants’ smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age. Results: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases). Conclusions: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change. %M 38922667 %R 10.2196/52831 %U https://aging.jmir.org/2024/1/e52831 %U https://doi.org/10.2196/52831 %U http://www.ncbi.nlm.nih.gov/pubmed/38922667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52248 %T User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study %A Adam,Esmee %A Meiland,Franka %A Frielink,Noud %A Meinders,Erwin %A Smits,Reon %A Embregts,Petri %A Smaling,Hanneke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 071 526 84 44, e.adam@lumc.nl %K stress detection %K sensor system %K garment integrated %K wearable %K user requirements %K dementia %K intellectual disability %K intellectual disabilities %K long-term care %K perceptions %K wearables %K qualitative study %K residents %K communication impairment %K impairments %K garment sensor %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. Objective: This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. Methods: A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. Results: The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. Conclusions: The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice. %R 10.2196/52248 %U https://formative.jmir.org/2024/1/e52248 %U https://doi.org/10.2196/52248 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e48129 %T The Value of a Virtual Assistant to Improve Engagement in Computerized Cognitive Training at Home: Exploratory Study %A Zsoldos,Isabella %A Trân,Eléonore %A Fournier,Hippolyte %A Tarpin-Bernard,Franck %A Fruitet,Joan %A Fouillen,Mélodie %A Bailly,Gérard %A Elisei,Frédéric %A Bouchot,Béatrice %A Constant,Patrick %A Ringeval,Fabien %A Koenig,Olivier %A Chainay,Hanna %+ Laboratoire d’Étude des Mécanismes Cognitifs, Université Lumière Lyon 2, 5 Avenue Pierre Mendès France, Lyon, 69500, France, 33 478774335, isabella.zsoldos@hotmail.fr %K cognitive training %K cognitive decline %K cognitive disorders %K mild cognitive impairment %K Alzheimer disease %K digital therapies %K virtual health assistant %K conversational agent %K artificial intelligence %K social interaction %K THERADIA %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Impaired cognitive function is observed in many pathologies, including neurodegenerative diseases such as Alzheimer disease. At present, the pharmaceutical treatments available to counter cognitive decline have only modest effects, with significant side effects. A nonpharmacological treatment that has received considerable attention is computerized cognitive training (CCT), which aims to maintain or improve cognitive functioning through repeated practice in standardized exercises. CCT allows for more regular and thorough training of cognitive functions directly at home, which represents a significant opportunity to prevent and fight cognitive decline. However, the presence of assistance during training seems to be an important parameter to improve patients’ motivation and adherence to treatment. To compensate for the absence of a therapist during at-home CCT, a relevant option could be to include a virtual assistant to accompany patients throughout their training. Objective: The objective of this exploratory study was to evaluate the interest of including a virtual assistant to accompany patients during CCT. We investigated the relationship between various individual factors (eg, age, psycho-affective functioning, personality, personal motivations, and cognitive skills) and the appreciation and usefulness of a virtual assistant during CCT. This study is part of the THERADIA (Thérapies Digitales Augmentées par l’Intelligence Artificielle) project, which aims to develop an empathetic virtual assistant. Methods: A total of 104 participants were recruited, including 52 (50%) young adults (mean age 21.2, range 18 to 27, SD 2.9 years) and 52 (50%) older adults (mean age 67.9, range 60 to 79, SD 5.1 years). All participants were invited to the laboratory to answer several questionnaires and perform 1 CCT session, which consisted of 4 cognitive exercises supervised by a virtual assistant animated by a human pilot via the Wizard of Oz method. The participants evaluated the virtual assistant and CCT at the end of the session. Results: Analyses were performed using the Bayesian framework. The results suggest that the virtual assistant was appreciated and perceived as useful during CCT in both age groups. However, older adults rated the assistant and CCT more positively overall than young adults. Certain characteristics of users, especially their current affective state (ie, arousal, intrinsic relevance, goal conduciveness, and anxiety state), appeared to be related to their evaluation of the session. Conclusions: This study provides, for the first time, insight into how young and older adults perceive a virtual assistant during CCT. The results suggest that such an assistant could have a beneficial influence on users’ motivation, provided that it can handle different situations, particularly their emotional state. The next step of our project will be to evaluate our device with patients experiencing mild cognitive impairment and to test its effectiveness in long-term cognitive training. %M 38901017 %R 10.2196/48129 %U https://rehab.jmir.org/2024/1/e48129 %U https://doi.org/10.2196/48129 %U http://www.ncbi.nlm.nih.gov/pubmed/38901017 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59294 %T Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study %A Pickett,Andrew C %A Valdez,Danny %A Sinclair,Kelsey L %A Kochell,Wesley J %A Fowler,Boone %A Werner,Nicole E %+ Department of Health & Wellness Design, School of Public Health, Indiana University, 1025 E 7th St, Bloomington, IN, 47405, United States, 1 812 855 1561, picketac@iu.edu %K caregiving %K dementia %K social support %K social media %K Reddit %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease–related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. Objective: We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. Methods: We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. Results: The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. Conclusions: Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD. %M 38896462 %R 10.2196/59294 %U https://aging.jmir.org/2024/1/e59294 %U https://doi.org/10.2196/59294 %U http://www.ncbi.nlm.nih.gov/pubmed/38896462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56484 %T The Effect of Acupuncture on Brain Iron Deposition and Body Iron Metabolism in Vascular Cognitive Impairment: Protocol for a Randomized Controlled Trial %A Wu,Mingli %A Chen,Lulu %A Wang,Yamin %A Li,Yunpeng %A An,Yuqi %A Wu,Ruonan %A Zhang,Yuhan %A Gao,Jing %A Su,Kaiqi %A Feng,Xiaodong %+ Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Jinshui District, Zhengzhou, 450099, China, 86 15303828605, fxd0502@163.com %K acupuncture %K vascular cognitive impairment %K iron metabolism %K mechanisms explored %K clinical trial %K needling technique %K dry needling %K acupunctures %K activities of daily living %K iron %K prevalence %K cerebrovascular diseases %K vascular dementia %K vascular %K traditional Chinese method %K Chinese methods %D 2024 %7 17.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vascular cognitive impairment (VCI) persistently impairs cognition and the ability to perform activities of daily living, seriously compromising patients’ quality of life. Previous studies have reported that disorders of serum iron metabolism and iron deposition in the brain can lead to inflammation, abnormal protein aggregation and degeneration, and massive neuronal apoptosis in the central nervous system, which in turn leads to a progressive decline in cognitive processes. Our previous clinical studies have found acupuncture to be a safe and effective intervention for treating VCI, but the specific mechanisms require further exploration. Objective: The objective of the trial is to evaluate the clinical efficacy of Tongdu Xingshen acupuncture and to investigate whether it can improve VCI by regulating brain iron deposition and body iron metabolism. Methods: In total, 42 patients with VCI and 21 healthy individuals will participate in this clinical trial. The 42 patients with VCI will be randomized into acupuncture and control groups, while the 21 healthy individuals will be in the healthy control group. Both the control and acupuncture groups will receive conventional medical treatment and cognitive rehabilitation training. In addition, the acupuncture group will receive electroacupuncture treatment with Tongdu Xingshen for 30 minutes each time, 6 times a week for 4 weeks. Meanwhile, the healthy control group will not receive any intervention. All 3 groups will undergo baseline assessments of brain iron deposition, serum iron metabolism, and neuropsychological tests after enrollment. The acupuncture and control groups will be evaluated again at the end of 4 weeks of treatment, as described earlier. By comparing neuropsychological test scores between groups, we will examine the efficacy of Tongdu Xingshen acupuncture in treating VCI. Additionally, we will test the correlations between neuropsychological test scores, brain iron deposition, and body iron metabolism indexes to explore the possible mechanisms of Tongdu Xingshen acupuncture in treating VCI. Results: Participants are currently being recruited. The first participant was enrolled in June 2023, which marked the official start of the experiment. As of the submission of the paper, there were 23 participants. The recruitment process is expected to continue until June 2025, at which point the processing and analysis of data will begin. As of May 15, 2024, up to 30 people have been enrolled in this clinical trial. Conclusions: This study will provide data on the effects of Tongdu Xingshen acupuncture on cerebral iron deposition as well as somatic iron metabolism in patients with VCI. These results will help to prove whether Tongdu Xingshen acupuncture can improve VCI by regulating brain iron deposition and body iron metabolism, which will provide the clinical and theoretical basis for the wide application of acupuncture therapy in VCI rehabilitation. Trial Registration: China Clinical Registration Agency ChiCTR2300072188; https://tinyurl.com/5fcydtkv International Registered Report Identifier (IRRID): PRR1-10.2196/56484 %M 38885500 %R 10.2196/56484 %U https://www.researchprotocols.org/2024/1/e56484 %U https://doi.org/10.2196/56484 %U http://www.ncbi.nlm.nih.gov/pubmed/38885500 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55216 %T The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study %A Mildrum Chana,Sofía %A Álvarez,Lorelí %A Poe,Abigail %A Bibriescas,Natashia %A Wang,Danny Hai %A DiFiglia,Stephanie %A Azuero,Andrés %A Crowe,Michael %A Puga,Frank %+ Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, NB 485A, 1701 University Blvd, Birmingham, AL, 35294, United States, 1 205 934 6487, fpuga@uab.edu %K dementia %K caregivers %K Hispanic %K Latinx %K mental health %K daily diary %K longitudinal %K protocol %K observational cohort study %K cohort %K Alzheimer’s disease %K Alzheimer %K stress %K burden %K mental health %K loneliness %K well-being %D 2024 %7 13.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. Objective: The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for “Nuestros Días” (Spanish for “our days”), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. Methods: The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. Results: Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. Conclusions: Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. International Registered Report Identifier (IRRID): DERR1-10.2196/55216 %M 38869929 %R 10.2196/55216 %U https://www.researchprotocols.org/2024/1/e55216 %U https://doi.org/10.2196/55216 %U http://www.ncbi.nlm.nih.gov/pubmed/38869929 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49618 %T Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period %A Pilunthanakul,Thanita %A Tan,Giles Ming Yee %+ MOH Holdings Pte Ltd, 1 Maritime Square, Singapore, 099253, Singapore, 65 66220980, thanita.pilunthanakul@mohh.com.sg %K dementia %K COVID-19 %K high dependency psychiatric unit %K psychiatric intensive care unit %K caregiver stress %K SARS-CoV-2 %K psychiatric %K psychiatry %K mental health %K health care system %K Alzheimer %K ward %K care facility %D 2024 %7 11.6.2024 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic led to behavioral exacerbations in people with dementia. Increased hospitalizations and lack of bed availability in specialized dementia wards at a tertiary psychiatric hospital in Singapore resulted in lodging people with dementia in the High Dependency Psychiatric Unit (HDPCU). Customizations to create a dementia-friendly environment at the HDPCU included: (1) environmental modifications to facilitate orientation and engender familiarity; (2) person-centered care to promote attachment, inclusion, identity, occupation, and comfort; (3) risk management for delirium; and (4) training core competencies. Such practical solutions can also be implemented elsewhere to help overcome resource constraints and repurpose services to accommodate increasing populations of people living with dementia. %M 38861715 %R 10.2196/49618 %U https://www.i-jmr.org/2024/1/e49618 %U https://doi.org/10.2196/49618 %U http://www.ncbi.nlm.nih.gov/pubmed/38861715 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58205 %T The Prevalence of Missing Incidents and Their Antecedents Among Older Adult MedicAlert Subscribers: Retrospective Descriptive Study %A Miguel-Cruz,Antonio %A Perez,Hector %A Choi,Yoojin %A Rutledge,Emily %A Daum,Christine %A Liu,Lili %+ Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada, 1 7802246641, miguelcr@ualberta.ca %K dementia %K Alzheimer disease %K memory loss %K cognitive impairment %K missing incident %K wandering %K critical wandering %K older adults %K retrospective design %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: With the population aging, the number of people living with dementia is expected to rise, which, in turn, is expected to lead to an increase in the prevalence of missing incidents due to critical wandering. However, the estimated prevalence of missing incidents due to dementia is inconclusive in some jurisdictions and overlooked in others. Objective: The aims of the study were to examine (1) the demographic, psychopathological, and environmental antecedents to missing incidents due to critical wandering among older adult MedicAlert Foundation Canada (hereinafter MedicAlert) subscribers; and (2) the characteristics and outcomes of the missing incidents. Methods: This study used a retrospective descriptive design. The sample included 434 older adult MedicAlert subscribers involved in 560 missing incidents between January 2015 and July 2021. Results: The sample was overrepresented by White older adults (329/425, 77.4%). MedicAlert subscribers reported missing were mostly female older adults (230/431, 53.4%), living in urban areas with at least 1 family member (277/433, 63.8%). Most of the MedicAlert subscribers (345/434, 79.5%) self-reported living with dementia. MedicAlert subscribers went missing most frequently from their private homes in the community (96/143, 67.1%), traveling on foot (248/270, 91.9%) and public transport (12/270, 4.4%), during the afternoon (262/560, 46.8%) and evening (174/560, 31.1%). Most were located by first responders (232/486, 47.7%) or Good Samaritans (224/486, 46.1%). Of the 560 missing incidents, 126 (22.5%) were repeated missing incidents. The mean time between missing incidents was 11 (SD 10.8) months. Finally, the majority of MedicAlert subscribers were returned home safely (453/500, 90.6%); and reports of harm, injuries (46/500, 9.2%), and death (1/500, 0.2%) were very low. Conclusions: This study provides the prevalence of missing incidents from 1 database source. The low frequency of missing incidents may not represent populations that are not White. Despite the low number of missing incidents, the 0.2% (1/500) of cases resulting in injuries or death are devastating experiences that may be mitigated through prevention strategies. %M 38857069 %R 10.2196/58205 %U https://aging.jmir.org/2024/1/e58205 %U https://doi.org/10.2196/58205 %U http://www.ncbi.nlm.nih.gov/pubmed/38857069 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50107 %T Smartwatch-Based Interventions for People With Dementia: User-Centered Design Approach %A Goerss,Doreen %A Köhler,Stefanie %A Rong,Eleonora %A Temp,Anna Gesine %A Kilimann,Ingo %A Bieber,Gerald %A Teipel,Stefan %+ Department of Psychosomatic Medicine, Rostock University Medical Center, Gehlsheimer Str. 20, Rostock, 18147, Germany, 49 3814949471, doreen.goerss@med.uni-rostock.de %K assistive technology %K user-centered design %K usability %K dementia %K smartwatch %K mobile phone %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Assistive technologies can help people living with dementia maintain their everyday activities. Nevertheless, there is a gap between the potential and use of these materials. Involving future users may help close this gap, but the impact on people with dementia is unclear. Objective: We aimed to determine if user-centered development of smartwatch-based interventions together with people with dementia is feasible. In addition, we evaluated the extent to which user feedback is plausible and therefore helpful for technological improvements. Methods: We examined the interactions between smartwatches and people with dementia or people with mild cognitive impairment. All participants were prompted to complete 2 tasks (drinking water and a specific cognitive task). Prompts were triggered using a smartphone as a remote control and were repeated up to 3 times if participants failed to complete a task. Overall, 50% (20/40) of the participants received regular prompts, and 50% (20/40) received intensive audiovisual prompts to perform everyday tasks. Participants’ reactions were observed remotely via cameras. User feedback was captured via questionnaires, which included topics like usability, design, usefulness, and concerns. The internal consistency of the subscales was calculated. Plausibility was also checked using qualitative approaches. Results: Participants noted their preferences for particular functions and improvements. Patients struggled with rating using the Likert scale; therefore, we assisted them with completing the questionnaire. Usability (mean 78 out of 100, SD 15.22) and usefulness (mean 9 out of 12) were rated high. The smartwatch design was appealing to most participants (31/40, 76%). Only a few participants (6/40, 15%) were concerned about using the watch. Better usability was associated with better cognition. The observed success and self-rated task comprehension were in agreement for most participants (32/40, 80%). In different qualitative analyses, participants’ responses were, in most cases, plausible. Only 8% (3/40) of the participants were completely unaware of their irregular task performance. Conclusions: People with dementia can have positive experiences with smartwatches. Most people with dementia provided valuable information. Developing assistive technologies together with people with dementia can help to prioritize the future development of functional and nonfunctional features. %M 38848116 %R 10.2196/50107 %U https://aging.jmir.org/2024/1/e50107 %U https://doi.org/10.2196/50107 %U http://www.ncbi.nlm.nih.gov/pubmed/38848116 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56726 %T Linking Dementia Pathology and Alteration in Brain Activation to Complex Daily Functional Decline During the Preclinical Dementia Stages: Protocol for a Prospective Observational Cohort Study %A De Sanctis,Pierfilippo %A Mahoney,Jeannette R %A Wagner,Johanna %A Blumen,Helena M %A Mowrey,Wenzhu %A Ayers,Emmeline %A Schneider,Claudia %A Orellana,Natasha %A Molholm,Sophie %A Verghese,Joe %+ Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, 1225 Morris Park Avenue, Bronx, NY, 10461-0000, United States, 1 7188621828, pierfilippo.sanctis@einsteinmed.edu %K EEG %K electroencephalographic %K mobility %K preclinical dementia stages %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Progressive difficulty in performing everyday functional activities is a key diagnostic feature of dementia syndromes. However, not much is known about the neural signature of functional decline, particularly during the very early stages of dementia. Early intervention before overt impairment is observed offers the best hope of reducing the burdens of Alzheimer disease (AD) and other dementias. However, to justify early intervention, those at risk need to be detected earlier and more accurately. The decline in complex daily function (CdF) such as managing medications has been reported to precede impairment in basic activities of daily living (eg, eating and dressing). Objective: Our goal is to establish the neural signature of decline in CdF during the preclinical dementia period. Methods: Gait is central to many CdF and community-based activities. Hence, to elucidate the neural signature of CdF, we validated a novel electroencephalographic approach to measuring gait-related brain activation while participants perform complex gait-based functional tasks. We hypothesize that dementia-related pathology during the preclinical period activates a unique gait-related electroencephalographic (grEEG) pattern that predicts a subsequent decline in CdF. Results: We provide preliminary findings showing that older adults reporting CdF limitations can be characterized by a unique gait-related neural signature: weaker sensorimotor and stronger motor control activation. This subsample also had smaller brain volume and white matter hyperintensities in regions affected early by dementia and engaged in less physical exercise. We propose a prospective observational cohort study in cognitively unimpaired older adults with and without subclinical AD (plasma amyloid-β) and vascular (white matter hyperintensities) pathologies. We aim to (1) establish the unique grEEG activation as the neural signature and predictor of decline in CdF during the preclinical dementia period; (2) determine associations between dementia-related pathologies and incidence of the neural signature of CdF; and (3) establish associations between a dementia risk factor, physical inactivity, and the neural signature of CdF. Conclusions: By establishing the clinical relevance and biological basis of the neural signature of CdF decline, we aim to improve prediction during the preclinical stages of ADs and other dementias. Our approach has important research and translational implications because grEEG protocols are relatively inexpensive and portable, and predicting CdF decline may have real-world benefits. International Registered Report Identifier (IRRID): DERR1-10.2196/56726 %M 38842914 %R 10.2196/56726 %U https://www.researchprotocols.org/2024/1/e56726 %U https://doi.org/10.2196/56726 %U http://www.ncbi.nlm.nih.gov/pubmed/38842914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49562 %T Identifying X (Formerly Twitter) Posts Relevant to Dementia and COVID-19: Machine Learning Approach %A Azizi,Mehrnoosh %A Jamali,Ali Akbar %A Spiteri,Raymond J %+ Department of Computer Science, University of Saskatchewan, S425 Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 306 966 2909, spiteri@cs.usask.ca %K machine learning %K dementia %K Alzheimer disease %K COVID-19 %K X (Twitter) %K natural language processing %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic, patients with dementia were identified as a vulnerable population. X (formerly Twitter) became an important source of information for people seeking updates on COVID-19, and, therefore, identifying posts (formerly tweets) relevant to dementia can be an important support for patients with dementia and their caregivers. However, mining and coding relevant posts can be daunting due to the sheer volume and high percentage of irrelevant posts. Objective: The objective of this study was to automate the identification of posts relevant to dementia and COVID-19 using natural language processing and machine learning (ML) algorithms. Methods: We used a combination of natural language processing and ML algorithms with manually annotated posts to identify posts relevant to dementia and COVID-19. We used 3 data sets containing more than 100,000 posts and assessed the capability of various algorithms in correctly identifying relevant posts. Results: Our results showed that (pretrained) transfer learning algorithms outperformed traditional ML algorithms in identifying posts relevant to dementia and COVID-19. Among the algorithms tested, the transfer learning algorithm A Lite Bidirectional Encoder Representations from Transformers (ALBERT) achieved an accuracy of 82.92% and an area under the curve of 83.53%. ALBERT substantially outperformed the other algorithms tested, further emphasizing the superior performance of transfer learning algorithms in the classification of posts. Conclusions: Transfer learning algorithms such as ALBERT are highly effective in identifying topic-specific posts, even when trained with limited or adjacent data, highlighting their superiority over other ML algorithms and applicability to other studies involving analysis of social media posts. Such an automated approach reduces the workload of manual coding of posts and facilitates their analysis for researchers and policy makers to support patients with dementia and their caregivers and other vulnerable populations. %M 38833288 %R 10.2196/49562 %U https://formative.jmir.org/2024/1/e49562 %U https://doi.org/10.2196/49562 %U http://www.ncbi.nlm.nih.gov/pubmed/38833288 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e55169 %T Perceptions and Utilization of Online Peer Support Among Informal Dementia Caregivers: Survey Study %A Yin,Zhijun %A Stratton,Lauren %A Song,Qingyuan %A Ni,Congning %A Song,Lijun %A Commiskey,Patricia %A Chen,Qingxia %A Moreno,Monica %A Fazio,Sam %A Malin,Bradley %K informal dementia caregiver %K online health community %K social support %K survey %K online peer support %K caregiving challenges %D 2024 %7 31.5.2024 %9 %J JMIR Aging %G English %X Background: Informal dementia caregivers are those who care for a person living with dementia and do not receive payment (eg, family members, friends, or other unpaid caregivers). These informal caregivers are subject to substantial mental, physical, and financial burdens. Online communities enable these caregivers to exchange caregiving strategies and communicate experiences with other caregivers whom they generally do not know in real life. Research has demonstrated the benefits of peer support in online communities, but this research is limited, focusing merely on caregivers who are already online community users. Objective: We aimed to investigate the perceptions and utilization of online peer support through a survey. Methods: Following the Andersen and Newman Framework of Health Services Utilization and using REDCap (Research Electronic Data Capture), we designed and administered a survey to investigate the perceptions and utilization of online peer support among informal dementia caregivers. Specifically, we collected types of information that influence whether an informal dementia caregiver accesses online peer support: predisposing factors, which refer to the sociocultural characteristics of caregivers, relationships between caregivers and people living with dementia, and belief in the value of online peer support; enabling factors, which refer to the logistic aspects of accessing online peer support (eg, eHealth literacy and access to high-speed internet); and need factors, which are the most immediate causes of seeking online peer support. We also collected data on caregivers’ experiences with accessing online communities. We distributed the survey link on November 14, 2022, within two online locations: the Alzheimer’s Association website (as an advertisement) and ALZConnected (an online community organized by the Alzheimer’s Association). We collected all responses on February 23, 2023, and conducted a regression analysis to identifyn factors that were associated with accessing online peer support. Results: We collected responses from 172 dementia caregivers. Of these participants, 140 (81.4%) completed the entire survey. These caregivers were aged 19 to 87 (mean 54, SD 13.5) years, and a majority were female (123/140, 87.9%) and White (126/140, 90%). Our findings show that the behavior of accessing any online community was significantly associated with participants’ belief in the value of online peer support (P=.006). Moreover, of the 40 non–online community caregivers, 33 (83%) had a belief score above 24—the score that was assigned when a neutral option was selected for each belief question. The most common reasons for not accessing any online community were having no time to do so (14/140, 10%) and having insufficient online information–searching skills (9/140, 6.4%). Conclusions: Our findings suggest that online peer support is valuable, but practical strategies are needed to assist informal dementia caregivers who have limited time or online information–searching skills. %R 10.2196/55169 %U https://aging.jmir.org/2024/1/e55169 %U https://doi.org/10.2196/55169 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56888 %T The Experience of Cancer-Related Cognitive Impairment Across Common Cancers: Protocol for a Qualitative Systematic Review %A Ibrar,Maryam %A Rai,Harleen Kaur %A Main,Ashleigh %A McCartney,Haruno %A Maguire,Roma %A Rodriguez,Mario Alfredo Parra %+ Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 7th Fl, 26 Richmond St, Glasgow, G1 1XH, United Kingdom, 44 7769914387, maryam.ibrar@strath.ac.uk %K cancer %K neoplasms %K cancer survivors %K cancer-related cognitive impairment %K chemotherapy-related cognitive impairment %K qualitative research %K executive function %K cognition %K cognitive impairment %K quality of life %K common cancer %K qualitative synthesis %K adult %K young adult %K functional ability %K functional outcome %K qualitative %K cognitive impairments %K cancer survivor %K survival rates %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer-related cognitive impairment (CRCI) is commonly experienced by patients with cancer during treatment, and 35% of patients experience cognitive impairment after treatment completion. Impairments in memory, attention, executive functioning, and information processing speed are most reported and often negatively impact daily functioning and quality of life (QoL). Despite the large scale of reports, this adverse side effect is underinvestigated across common cancer types, and there is a lack of insight into the CRCI experience. Objective: This qualitative synthesis aims to explore the evidence in relation to the experience of CRCI across common cancers. It also aims to understand the prevalence of CRCI across various cancer types, cognitive domains, and its impact on QoL and functional ability. Methods: A comprehensive search of databases, including PubMed, American Psychological Association PsycINFO, CINAHL, and Scopus, will be conducted. A total of 2 independent reviewers will screen titles and abstracts for inclusion, followed by full-text screening. A third reviewer will resolve any arising conflicts in the process of data screening and inclusion. Subsequently, data extraction and quality assessment using the Critical Appraisal Skills Programme (CASP) tool will be conducted. The results will be analyzed using thematic analysis. Results: This review is part of a PhD program funded in January 2023. The review commenced in June 2023, and data analysis is currently in progress. The qualitative synthesis will explore the experiences of CRCI across common cancers. The included studies are expected to report on numerous cancer types such as breast cancer, prostate cancer, leukemia, and lung cancer. The included study types are most likely to be interviews, focus groups, and surveys with qualitative components. Conclusions: This protocol highlights the need for a qualitative synthesis that will explore the experience of CRCI across common cancer types. It will provide valuable insight into the lived experience of CRCI and the cognitive domains that may be disproportionately affected. There is a growing demand for further management interventions and clinically tested treatments of CRCI and the qualitative exploration of patient experience is crucial for their development. This qualitative synthesis will inform future developments and will contribute to improving QoL after cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/56888 %M 38820581 %R 10.2196/56888 %U https://www.researchprotocols.org/2024/1/e56888 %U https://doi.org/10.2196/56888 %U http://www.ncbi.nlm.nih.gov/pubmed/38820581 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49790 %T Relationship Between Physical Exercise and Cognitive Function Among Older Adults in China: Cross-Sectional Population-Based Study %A Wang,Fubaihui %A Gao,Changqing %A Wang,Yantao %A Li,Zhuo %A Zheng,Feiran %A Luo,Yanan %+ Department of Global Health, School of Public Health, Peking University, No 38 Xuyuan Road, Haidian District, Beijing, 100191, China, 86 18519621115, luoyanan@bjmu.edu.cn %K cognitive function %K exercise %K physical activity %K mindfulness %K cognitive exercise %K mind stimulation %K dementia treatment %K cognitive intervention %K cognitive treatment %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The existing literature reveals several significant knowledge gaps that hinder health care providers in formulating exercise prescriptions for cognitive health. Objective: This study endeavors to elucidate the relationship between the level of physical activity and cognitive function in older adults in China. Moreover, it seeks to explore the associations between distinct exercise behaviors—such as exercise types, the purpose motivating engagement in exercise, the accessibility of exercise fields, and the inclination toward exercise—and cognitive function. Methods: Using data from the China Longitudinal Aging Social Survey (CLASS conducted in 2016, cognitive function was meticulously assessed through the modified Chinese version of the Mini-Mental State Examination, encompassing measures of orientation, memory, and calculation. Using self-report structured questionnaires, a myriad of information about physical activity during leisure time, exercise engagement, exercise intensity, primary exercise types, reasons for exercise participation, availability of sports facilities, and exercise willingness was diligently gathered. Robust ordinary least squares regression models were then used to compute coefficients along with 95% CIs. Results: A discernible inverted U-shaped trend in cognitive scores emerged as the level of physical activity surpassed the threshold of 500 metabolic equivalents of task (MET) minutes per week. Notably, individuals with a physical activity level between 500 and 999 MET minutes per week exhibited a coefficient of 0.31 (95% CI 0.09 to 0.54), those with a physical activity level between 1000 and 1499 MET minutes per week displayed a coefficient of 0.75 (95% CI 0.52 to 0.97), and those with a physical activity level above 1500 MET minutes per week demonstrated a coefficient of 0.45 (95% CI 0.23 to 0.68). Older individuals engaging in exercise at specific MET levels showcased superior cognitive function compared to their inactive counterparts. Furthermore, individuals driven by exercise motivations aimed at enhancing physical fitness and health, as well as those using sports facilities or public spaces for exercise, exhibited notably higher cognitive function scores. Conclusions: The findings underscore the potential of exercise as a targeted intervention for the prevention and treatment of dementia or cognitive decline associated with aging in older individuals. Leveraging these insights to formulate informed exercise recommendations holds promise in addressing a significant public health challenge linked to aging populations. %M 38815262 %R 10.2196/49790 %U https://publichealth.jmir.org/2024/1/e49790 %U https://doi.org/10.2196/49790 %U http://www.ncbi.nlm.nih.gov/pubmed/38815262 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56668 %T Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study %A Morita,Kentaro %A Miura,Kenichiro %A Toyomaki,Atsuhito %A Makinodan,Manabu %A Ohi,Kazutaka %A Hashimoto,Naoki %A Yasuda,Yuka %A Mitsudo,Takako %A Higuchi,Fumihiro %A Numata,Shusuke %A Yamada,Akiko %A Aoki,Yohei %A Honda,Hiromitsu %A Mizui,Ryo %A Honda,Masato %A Fujikane,Daisuke %A Matsumoto,Junya %A Hasegawa,Naomi %A Ito,Satsuki %A Akiyama,Hisashi %A Onitsuka,Toshiaki %A Satomura,Yoshihiro %A Kasai,Kiyoto %A Hashimoto,Ryota %+ Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187 8553, Japan, 81 42 346 2046, ryotahashimoto55@ncnp.go.jp %K schizophrenia %K cognitive function %K eye movement %K diagnostic biomarkers %K digital health tools %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking. Objective: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia. Methods: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest. Results: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions. Conclusions: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation. %M 38815257 %R 10.2196/56668 %U https://mental.jmir.org/2024/1/e56668 %U https://doi.org/10.2196/56668 %U http://www.ncbi.nlm.nih.gov/pubmed/38815257 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e54496 %T Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review %A Fernandes,Sofia %A von Gunten,Armin %A Verloo,Henk %+ School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Chemin de l’Agasse 5, Sion, 1950, Switzerland, 41 00415860861, sofia.fernandes@hevs.ch %K artificial intelligence %K behavioral and psychological symptoms of dementia %K neuropsychiatric symptoms %K early detection %K management %K narrative literature review %D 2024 %7 28.5.2024 %9 Review %J JMIR Nursing %G English %X Background: The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence–based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. Objective: The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. Methods: A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. Results: A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. Conclusions: Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions. %M 38805252 %R 10.2196/54496 %U https://nursing.jmir.org/2024/1/e54496 %U https://doi.org/10.2196/54496 %U http://www.ncbi.nlm.nih.gov/pubmed/38805252 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e41202 %T Usability, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology-Supported Mental Health Intervention for Family Caregivers of People With Dementia: Field Usability Study %A Collins-Pisano,Caroline %A Leggett,Amanda N %A Gambee,David %A Fortuna,Karen L %+ Department of Psychology, University of Colorado, Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO, 80918, United States, 1 (719) 255 8227, ccolli20@uccs.edu %K family caregivers %K dementia %K peer support %K technology %K mobile phone %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of health care systems but face an increased risk of emotional distress and negative physical and mental health outcomes. Objective: The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and caregiver-delivered peer support program, the Caregiver Remote Education and Support (CARES) smartphone or tablet app. Methods: A total of 9 adult family caregivers of people with dementia received the CARES intervention, and 3 former family caregivers of people with dementia were trained to deliver it. Quantitative data were collected at baseline and at the end of the 2-week field usability study. Qualitative data were also collected at the end of the 2-week field usability study. Results: The field usability study demonstrated that a 2-week peer-delivered and technology-supported mental health intervention designed to improve burden, stress, and strain levels was experienced by former and current family caregivers of people with dementia as acceptable. Current family caregivers rated CARES as above average in usability, whereas the caregiver peer supporters rated CARES as marginally usable. CARES was associated with non–statistically significant improvements in burden, stress, and strain levels. Conclusions: This field usability study demonstrated that it is possible to train former family caregivers of people with dementia to use technology to deliver a mental health intervention to current family caregivers of people with dementia. Future studies would benefit from a longer trial; a larger sample size; a randomized controlled design; and a control of covariables such as stages of dementia, years providing care, and severity of dementia symptoms. %M 38801660 %R 10.2196/41202 %U https://humanfactors.jmir.org/2024/1/e41202 %U https://doi.org/10.2196/41202 %U http://www.ncbi.nlm.nih.gov/pubmed/38801660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52389 %T Adapting a Dutch Web-Based Intervention to Support Family Caregivers of People With Dementia in the UK Context: Accelerated Experience-Based Co-Design %A Scheibl,Fiona %A Boots,Lizzy %A Eley,Ruth %A Fox,Christopher %A Gracey,Fergus %A Harrison Dening,Karen %A Oyebode,Jan %A Penhale,Bridget %A Poland,Fiona %A Ridel,Gemma %A West,Juniper %A Cross,Jane L %+ Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 (0) 1603593315, J.Cross@uea.ac.uk %K adaptation %K caregivers %K dementia %K intervention %K web-based resources %K United Kingdom %K co-design %K web-based intervention %K support %K carer %K caregiver %K family carer %K community-based %K services %K dementia %K web-based support %K staff %K self-help, web-based %D 2024 %7 22.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Around 700,000 family caregivers provide unpaid care for 900,000 people living with dementia in the United Kingdom. Few family caregivers receive support for their own psychological needs and funding for community respite services has declined. These trends are seen across Europe as demographic and budgetary pressures have intensified due to public spending cuts arising from the 2008 financial crisis and the COVID-19 pandemic. The World Health Organization has prioritized the need to expand the provision of support for caregivers and families of people with dementia by 2025. Web-based interventions have the potential for development as they require modest investment and can be accessed by family caregivers at home. Further cost benefits can be realized by adapting existing interventions with demonstrated effectiveness for new contexts. This paper reports initial findings from the CareCoach study, which is adapting Partner in Balance (PiB), a web-based coaching intervention developed in the Netherlands, for family caregivers in the United Kingdom. Objective: This study aims to work with unpaid family caregivers and staff in adapting the Dutch web-based support tool PiB to improve its acceptability and usability for use in the United Kingdom. Methods: Accelerated Experience-Based Co-Design (AEBCD) was used with caregivers, staff, and core stakeholders. Interviews, workshops, and stakeholder consultations were conducted. Data were analyzed iteratively. Recommendations for the redesign of PiB for use across the United Kingdom were adjudicated by the study Adaptation Working Party. Results: Sixteen caregivers and 17 staff took part in interviews. Thirteen caregivers and 17 staff took part in workshops. Most (n=26) participants were White, female, and retired. All except 4 caregivers (2 male and 2 female) found the PiB’s offer of web-based self-help learning acceptable. Caregivers identified complexity and lack of inclusivity in some wording and video resources as problematic. The staff took a stronger perspective on the lack of inclusivity in PiB video resources. Staff and caregivers coproduced new inclusive wording and recommended creating new videos to adapt PiB for the UK context. Conclusions: AEBCD methods facilitated the engagement of caregivers and staff and advanced the adaptation of the PiB complex intervention. An important addition to the AEBCD method in this process was the work of an Adaptation Working Party, which adjudicated and agreed to new wording where this could not be established in consultation with caregivers and staff. Trial Registration: ISRCTN Registry ISRCTN12540555; https://doi.org/10.1186/ISRCTN12540555 %M 38776139 %R 10.2196/52389 %U https://formative.jmir.org/2024/1/e52389 %U https://doi.org/10.2196/52389 %U http://www.ncbi.nlm.nih.gov/pubmed/38776139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55064 %T Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations %A Arsenault-Lapierre,Genevieve %A Lemay-Compagnat,Alexandra %A Guillette,Maxime %A Couturier,Yves %A Massamba,Victoria %A Dufour,Isabelle %A Maubert,Eric %A Fournier,Christine %A Denis,Julie %A Morin,Caroline %A Vedel,Isabelle %+ Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, 5800 Boulevard Cavendish suite 600, Côte Saint-Luc, QC, H4W 2T5, Canada, 1 514 484 7878 ext 61553, genevieve.arsenault-lapierre@mail.mcgill.ca %K dashboard %K learning health system %K health policy %K dementia care %K health care regionalization %K dementia %K Alzheimer disease %K qualitative %K collaborative %K focus group %K primary care %K implementation %K attitude %K opinion %K perception %K perspective %K service %K health care management %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization’s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled “university/peripheral”; organizations for which only part of the territory is in rural areas, labeled “mixed”; and organizations in remote or isolated areas, labeled “remote/isolated”) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. %M 38717803 %R 10.2196/55064 %U https://formative.jmir.org/2024/1/e55064 %U https://doi.org/10.2196/55064 %U http://www.ncbi.nlm.nih.gov/pubmed/38717803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53192 %T Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study %A Au-Yeung,Wan-Tai M %A Liu,Yan %A Hanna,Remonda %A Gothard,Sarah %A Rodrigues,Nathaniel %A Leon Guerrero,Cierra %A Beattie,Zachary %A Kaye,Jeffrey %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode: UHN13, Portland, OR, 97239, United States, 1 503 494 6695, auyeungm@ohsu.edu %K neuropsychiatric symptoms %K mild cognitive impairment %K dementia %K unobtrusive monitoring %K digital biomarkers %K environmental precipitants %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes. Objective: We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment. Methods: The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants’ digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed. Results: At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants’ severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants. Conclusions: This study is a step toward more frequent assessment of older adults’ behavioral symptoms and holistic in situ monitoring of older adults’ behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms. %M 38717798 %R 10.2196/53192 %U https://formative.jmir.org/2024/1/e53192 %U https://doi.org/10.2196/53192 %U http://www.ncbi.nlm.nih.gov/pubmed/38717798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55211 %T Association of Rest-Activity Rhythm and Risk of Developing Dementia or Mild Cognitive Impairment in the Middle-Aged and Older Population: Prospective Cohort Study %A Haghayegh,Shahab %A Gao,Chenlu %A Sugg,Elizabeth %A Zheng,Xi %A Yang,Hui-Wen %A Saxena,Richa %A Rutter,Martin K %A Weedon,Michael %A Ibanez,Agustin %A Bennett,David A %A Li,Peng %A Gao,Lei %A Hu,Kun %+ Massachusetts General Hospital, 149 13th Street, 4th Floor, Boston, MA, 02129, United States, 1 5129543436, shaghayegh@mgh.harvard.edu %K circadian rhythm %K dementia %K actigraphy %K cognitive decline %K RAR %K rest-activity rhythms %K cognitive impairment %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The relationship between 24-hour rest-activity rhythms (RARs) and risk for dementia or mild cognitive impairment (MCI) remains an area of growing interest. Previous studies were often limited by small sample sizes, short follow-ups, and older participants. More studies are required to fully explore the link between disrupted RARs and dementia or MCI in middle-aged and older adults. Objective: We leveraged the UK Biobank data to examine how RAR disturbances correlate with the risk of developing dementia and MCI in middle-aged and older adults. Methods: We analyzed the data of 91,517 UK Biobank participants aged between 43 and 79 years. Wrist actigraphy recordings were used to derive nonparametric RAR metrics, including the activity level of the most active 10-hour period (M10) and its midpoint, the activity level of the least active 5-hour period (L5) and its midpoint, relative amplitude (RA) of the 24-hour cycle [RA=(M10-L5)/(M10+L5)], interdaily stability, and intradaily variability, as well as the amplitude and acrophase of 24-hour rhythms (cosinor analysis). We used Cox proportional hazards models to examine the associations between baseline RAR and subsequent incidence of dementia or MCI, adjusting for demographic characteristics, comorbidities, lifestyle factors, shiftwork status, and genetic risk for Alzheimer's disease. Results: During the follow-up of up to 7.5 years, 555 participants developed MCI or dementia. The dementia or MCI risk increased for those with lower M10 activity (hazard ratio [HR] 1.28, 95% CI 1.14-1.44, per 1-SD decrease), higher L5 activity (HR 1.15, 95% CI 1.10-1.21, per 1-SD increase), lower RA (HR 1.23, 95% CI 1.16-1.29, per 1-SD decrease), lower amplitude (HR 1.32, 95% CI 1.17-1.49, per 1-SD decrease), and higher intradaily variability (HR 1.14, 95% CI 1.05-1.24, per 1-SD increase) as well as advanced L5 midpoint (HR 0.92, 95% CI 0.85-0.99, per 1-SD advance). These associations were similar in people aged <70 and >70 years, and in non–shift workers, and they were independent of genetic and cardiovascular risk factors. No significant associations were observed for M10 midpoint, interdaily stability, or acrophase. Conclusions: Based on findings from a large sample of middle-to-older adults with objective RAR assessment and almost 8-years of follow-up, we suggest that suppressed and fragmented daily activity rhythms precede the onset of dementia or MCI and may serve as risk biomarkers for preclinical dementia in middle-aged and older adults. %M 38713911 %R 10.2196/55211 %U https://publichealth.jmir.org/2024/1/e55211 %U https://doi.org/10.2196/55211 %U http://www.ncbi.nlm.nih.gov/pubmed/38713911 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53019 %T Assessing the Quality of ChatGPT Responses to Dementia Caregivers’ Questions: Qualitative Analysis %A Aguirre,Alyssa %A Hilsabeck,Robin %A Smith,Tawny %A Xie,Bo %A He,Daqing %A Wang,Zhendong %A Zou,Ning %K Alzheimer’s disease %K information technology %K social media %K neurology %K dementia %K Alzheimer disease %K caregiver %K ChatGPT %D 2024 %7 6.5.2024 %9 %J JMIR Aging %G English %X Background: Artificial intelligence (AI) such as ChatGPT by OpenAI holds great promise to improve the quality of life of patients with dementia and their caregivers by providing high-quality responses to their questions about typical dementia behaviors. So far, however, evidence on the quality of such ChatGPT responses is limited. A few recent publications have investigated the quality of ChatGPT responses in other health conditions. Our study is the first to assess ChatGPT using real-world questions asked by dementia caregivers themselves. Objectives: This pilot study examines the potential of ChatGPT-3.5 to provide high-quality information that may enhance dementia care and patient-caregiver education. Methods: Our interprofessional team used a formal rating scale (scoring range: 0-5; the higher the score, the better the quality) to evaluate ChatGPT responses to real-world questions posed by dementia caregivers. We selected 60 posts by dementia caregivers from Reddit, a popular social media platform. These posts were verified by 3 interdisciplinary dementia clinicians as representing dementia caregivers’ desire for information in the areas of memory loss and confusion, aggression, and driving. Word count for posts in the memory loss and confusion category ranged from 71 to 531 (mean 218; median 188), aggression posts ranged from 58 to 602 words (mean 254; median 200), and driving posts ranged from 93 to 550 words (mean 272; median 276). Results: ChatGPT’s response quality scores ranged from 3 to 5. Of the 60 responses, 26 (43%) received 5 points, 21 (35%) received 4 points, and 13 (22%) received 3 points, suggesting high quality. ChatGPT obtained consistently high scores in synthesizing information to provide follow-up recommendations (n=58, 96%), with the lowest scores in the area of comprehensiveness (n=38, 63%). Conclusions: ChatGPT provided high-quality responses to complex questions posted by dementia caregivers, but it did have limitations. ChatGPT was unable to anticipate future problems that a human professional might recognize and address in a clinical encounter. At other times, ChatGPT recommended a strategy that the caregiver had already explicitly tried. This pilot study indicates the potential of AI to provide high-quality information to enhance dementia care and patient-caregiver education in tandem with information provided by licensed health care professionals. Evaluating the quality of responses is necessary to ensure that caregivers can make informed decisions. ChatGPT has the potential to transform health care practice by shaping how caregivers receive health information. %R 10.2196/53019 %U https://aging.jmir.org/2024/1/e53019 %U https://doi.org/10.2196/53019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51076 %T Attributes, Quality, and Downloads of Dementia-Related Mobile Apps for Patients With Dementia and Their Caregivers: App Review and Evaluation Study %A Chen,Tzu Han %A Lee,Shin-Da %A Ma,Wei-Fen %+ PhD Program in Healthcare Science, School of Nursing, China Medical University, No 100, Sec 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, 886 4 22053366 ext 7107, lhdaisy@mail.cmu.edu.tw %K app quality %K caregiver %K dementia %K geriatrics %K aging %K technology %K digital health %K mHealth %K mobile health %K seniors %K mobile app %K patient %K adoption %K development %K management %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of mobile health (mHealth) apps among older adults (>65 years) is rapidly increasing. However, use of such apps has not been fully effective in supporting people with dementia and their caregivers in their daily lives. This is mainly attributed to the heterogeneous quality of mHealth apps, highlighting the need for improved app quality in the development of dementia-related mHealth apps. Objective: The aims of this study were (1) to assess the quality and content of mobile apps for dementia management and (2) to investigate the relationship between app quality and download numbers. Methods: We reviewed dementia-related mHealth apps available in the Google Play Store and Apple App Store in Taiwan. The identified mobile apps were stratified according to a random sampling approach and evaluated by five independent reviewers with sufficient training and proficiency in the field of mHealth and the related health care sector. App quality was scored according to the user version of the Mobile Application Rating Scale. A correlation analysis was then performed between the app quality score and number of app downloads. Results: Among the 17 apps that were evaluated, only one was specifically designed to provide dementia-related education. The mean score for the overall app quality was 3.35 (SD 0.56), with the engagement (mean 3.04, SD 0.82) and information (mean 3.14, SD 0.88) sections of the scale receiving the lowest ratings. Our analyses showed clear differences between the top three– and bottom three–rated apps, particularly in the entertainment and interest subsections of the engagement category where the ratings ranged from 1.4 to 5. The top three apps had a common feature in their interface, which included memory, attention, focus, calculation, and speed-training games, whereas the apps that received lower ratings were found to be deficient in providing adequate information. Although there was a correlation between the number of downloads (5000 or more) and app quality (t15=4.087, P<.001), this may not be a significant determinant of the app’s perceived impact. Conclusions: The quality of dementia-related mHealth apps is highly variable. In particular, our results show that the top three quality apps performed well in terms of engagement and information, and they all received more than 5000 downloads. The findings of this study are limited due to the small sample size and possibility of disregarding exceptional occurrences. Publicly available expert ratings of mobile apps could help people with dementia and their caregivers choose a quality mHealth app. %M 38684083 %R 10.2196/51076 %U https://formative.jmir.org/2024/1/e51076 %U https://doi.org/10.2196/51076 %U http://www.ncbi.nlm.nih.gov/pubmed/38684083 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50537 %T Automatic Spontaneous Speech Analysis for the Detection of Cognitive Functional Decline in Older Adults: Multilanguage Cross-Sectional Study %A Ambrosini,Emilia %A Giangregorio,Chiara %A Lomurno,Eugenio %A Moccia,Sara %A Milis,Marios %A Loizou,Christos %A Azzolino,Domenico %A Cesari,Matteo %A Cid Gala,Manuel %A Galán de Isla,Carmen %A Gomez-Raja,Jonathan %A Borghese,Nunzio Alberto %A Matteucci,Matteo %A Ferrante,Simona %+ Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, 20133, Italy, 39 0223999509, emilia.ambrosini@polimi.it %K cognitive decline %K speech processing %K machine learning %K multilanguage %K Mini-Mental Status Examination %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The rise in life expectancy is associated with an increase in long-term and gradual cognitive decline. Treatment effectiveness is enhanced at the early stage of the disease. Therefore, there is a need to find low-cost and ecological solutions for mass screening of community-dwelling older adults. Objective: This work aims to exploit automatic analysis of free speech to identify signs of cognitive function decline. Methods: A sample of 266 participants older than 65 years were recruited in Italy and Spain and were divided into 3 groups according to their Mini-Mental Status Examination (MMSE) scores. People were asked to tell a story and describe a picture, and voice recordings were used to extract high-level features on different time scales automatically. Based on these features, machine learning algorithms were trained to solve binary and multiclass classification problems by using both mono- and cross-lingual approaches. The algorithms were enriched using Shapley Additive Explanations for model explainability. Results: In the Italian data set, healthy participants (MMSE score≥27) were automatically discriminated from participants with mildly impaired cognitive function (20≤MMSE score≤26) and from those with moderate to severe impairment of cognitive function (11≤MMSE score≤19) with accuracy of 80% and 86%, respectively. Slightly lower performance was achieved in the Spanish and multilanguage data sets. Conclusions: This work proposes a transparent and unobtrusive assessment method, which might be included in a mobile app for large-scale monitoring of cognitive functionality in older adults. Voice is confirmed to be an important biomarker of cognitive decline due to its noninvasive and easily accessible nature. %M 38386279 %R 10.2196/50537 %U https://aging.jmir.org/2024/1/e50537 %U https://doi.org/10.2196/50537 %U http://www.ncbi.nlm.nih.gov/pubmed/38386279 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50234 %T Developing Social Enhancements for a Web-Based, Positive Emotion Intervention for Alzheimer Disease Caregivers: Qualitative Focus Group and Interview Study %A Kwok,Ian %A Lattie,Emily Gardiner %A Yang,Dershung %A Summers,Amanda %A Cotten,Paul %A Leong,Caroline Alina %A Moskowitz,Judith Tedlie %+ Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K Alzheimer disease %K dementia %K caregiving %K eHealth %K web-based interventions %K positive emotion %K stress %K coping %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of these responsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychological outcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being among dementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the format required significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed to develop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for social connection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention. In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features (eg, discussion board, automated support, and profiles) to maximize engagement among participants. Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previous version of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had not previously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted a qualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented in a way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, including the discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation. For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the duration of the study. However, they expressed concern about differing expectations among caregivers and the possibility of matched caregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, which would allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of social features that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve the acceptability of the features among caregivers. These insights will allow us to design social features for the intervention that are optimally engaging and helpful for caregivers. %M 38662432 %R 10.2196/50234 %U https://formative.jmir.org/2024/1/e50234 %U https://doi.org/10.2196/50234 %U http://www.ncbi.nlm.nih.gov/pubmed/38662432 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e47229 %T Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial %A Tokunaga,Seiki %A Sekiguchi,Takuya %A Watanabe Miura,Kumi %A Sugimoto,Hikaru %A S Abe,Masato %A Tamura,Kazuhiro %A Kishimoto,Taishiro %A Kudo,Takashi %A Otake-Matsuura,Mihoko %K cognitive intervention %K home-based experiment %K robots %K older adults %K technology adoption %K digital health %D 2024 %7 22.4.2024 %9 %J JMIR Aging %G English %X Background: Asking questions is common in conversations, and while asking questions, we need to listen carefully to what others say and consider the perspective our questions adopt. However, difficulties persist in verifying the effect of asking questions on older adults’ cognitive function due to the lack of a standardized system for conducting experiments at participants’ homes. Objective: This study examined the intervention effect of cognitive training moderated by robots on healthy older adults. A focus on the feasibility of the intervention at participants’ homes was also maintained. Feasibility was evaluated by considering both the dropout rate during the intervention and the number of questions posed to each participant during the experiment. Methods: We conducted a randomized controlled trial with 81 adults older than 65 years. Participants were recruited through postal invitations and then randomized into 2 groups. The intervention group (n=40) received sessions where participants listened to photo-integrated stories and posed questions to the robots. The control group (n=41) received sessions where participants listened to photo-integrated stories and only thanked the robots for confirming participation. The participants participated in 12 dialogue sessions for 2-3 weeks. Scores of global cognitive functioning tests, recall tests, and verbal fluency tasks measured before and after the intervention were compared between the 2 groups. Results: There was no significant intervention effect on the Telephone Interview for Cognitive Status-Japanese scores, recall tests, and verbal fluency tasks. Additionally, our study successfully concluded with no participant dropouts at follow-up, confirming the feasibility of our approach. Conclusions: There was no statistically significant evidence indicating intervention benefits for cognitive functioning. Although the feasibility of home-based interventions was demonstrated, we identified areas for improvement in the future, such as setting up more efficient session themes. Further research is required to identify the effectiveness of an improved cognitive intervention involving the act of asking questions. Trial Registration: University Hospital Medical Information Network Center UMIN000039489; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045027 %R 10.2196/47229 %U https://aging.jmir.org/2024/1/e47229 %U https://doi.org/10.2196/47229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56883 %T Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Pang,Wei %A Holyoke,Paul %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia neuropsychological tests %K evaluation study %K technology %K aged %K mobile phone %D 2024 %7 19.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale–10 to assess general anxiety levels at each cognitive screening. The SCREEN’s scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN’s longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 %M 38640480 %R 10.2196/56883 %U https://www.jmir.org/2024/1/e56883 %U https://doi.org/10.2196/56883 %U http://www.ncbi.nlm.nih.gov/pubmed/38640480 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e50219 %T Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study %A Bults,Marloes %A van Leersum,Catharina Margaretha %A Olthuis,Theodorus Johannes Josef %A Siebrand,Egbert %A Malik,Zohrah %A Liu,Lili %A Miguel-Cruz,Antonio %A Jukema,Jan Seerp %A den Ouden,Marjolein Elisabeth Maria %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, M H Tromplaan 28 Enschede, Enschede, 7513 AB, Netherlands, 31 620946213, m.bults@saxion.nl %K assistive technology %K technology acceptance %K immigrant %K dementia %K marginalized older adults %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one’s home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. %M 38639994 %R 10.2196/50219 %U https://aging.jmir.org/2024/1/e50219 %U https://doi.org/10.2196/50219 %U http://www.ncbi.nlm.nih.gov/pubmed/38639994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46777 %T The Alzheimer’s Knowledge Base: A Knowledge Graph for Alzheimer Disease Research %A Romano,Joseph D %A Truong,Van %A Kumar,Rachit %A Venkatesan,Mythreye %A Graham,Britney E %A Hao,Yun %A Matsumoto,Nick %A Li,Xi %A Wang,Zhiping %A Ritchie,Marylyn D %A Shen,Li %A Moore,Jason H %+ Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, 403 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 2155735571, joseph.romano@pennmedicine.upenn.edu %K Alzheimer disease %K knowledge graph %K knowledge base %K artificial intelligence %K drug repurposing %K drug discovery %K open source %K Alzheimer %K etiology %K heterogeneous graph %K therapeutic targets %K machine learning %K therapeutic discovery %D 2024 %7 18.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: As global populations age and become susceptible to neurodegenerative illnesses, new therapies for Alzheimer disease (AD) are urgently needed. Existing data resources for drug discovery and repurposing fail to capture relationships central to the disease’s etiology and response to drugs. Objective: We designed the Alzheimer’s Knowledge Base (AlzKB) to alleviate this need by providing a comprehensive knowledge representation of AD etiology and candidate therapeutics. Methods: We designed the AlzKB as a large, heterogeneous graph knowledge base assembled using 22 diverse external data sources describing biological and pharmaceutical entities at different levels of organization (eg, chemicals, genes, anatomy, and diseases). AlzKB uses a Web Ontology Language 2 ontology to enforce semantic consistency and allow for ontological inference. We provide a public version of AlzKB and allow users to run and modify local versions of the knowledge base. Results: AlzKB is freely available on the web and currently contains 118,902 entities with 1,309,527 relationships between those entities. To demonstrate its value, we used graph data science and machine learning to (1) propose new therapeutic targets based on similarities of AD to Parkinson disease and (2) repurpose existing drugs that may treat AD. For each use case, AlzKB recovers known therapeutic associations while proposing biologically plausible new ones. Conclusions: AlzKB is a new, publicly available knowledge resource that enables researchers to discover complex translational associations for AD drug discovery. Through 2 use cases, we show that it is a valuable tool for proposing novel therapeutic hypotheses based on public biomedical knowledge. %M 38635981 %R 10.2196/46777 %U https://www.jmir.org/2024/1/e46777 %U https://doi.org/10.2196/46777 %U http://www.ncbi.nlm.nih.gov/pubmed/38635981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54538 %T Integrating Biomarkers From Virtual Reality and Magnetic Resonance Imaging for the Early Detection of Mild Cognitive Impairment Using a Multimodal Learning Approach: Validation Study %A Park,Bogyeom %A Kim,Yuwon %A Park,Jinseok %A Choi,Hojin %A Kim,Seong-Eun %A Ryu,Hokyoung %A Seo,Kyoungwon %+ Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Sangsang Hall, 4th Fl, Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul, 01811, Republic of Korea, 82 010 5668 8660, kwseo@seoultech.ac.kr %K magnetic resonance imaging %K MRI %K virtual reality %K VR %K early detection %K mild cognitive impairment %K multimodal learning %K hand movement %K eye movement %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection of mild cognitive impairment (MCI), a transitional stage between normal aging and Alzheimer disease, is crucial for preventing the progression of dementia. Virtual reality (VR) biomarkers have proven to be effective in capturing behaviors associated with subtle deficits in instrumental activities of daily living, such as challenges in using a food-ordering kiosk, for early detection of MCI. On the other hand, magnetic resonance imaging (MRI) biomarkers have demonstrated their efficacy in quantifying observable structural brain changes that can aid in early MCI detection. Nevertheless, the relationship between VR-derived and MRI biomarkers remains an open question. In this context, we explored the integration of VR-derived and MRI biomarkers to enhance early MCI detection through a multimodal learning approach. Objective: We aimed to evaluate and compare the efficacy of VR-derived and MRI biomarkers in the classification of MCI while also examining the strengths and weaknesses of each approach. Furthermore, we focused on improving early MCI detection by leveraging multimodal learning to integrate VR-derived and MRI biomarkers. Methods: The study encompassed a total of 54 participants, comprising 22 (41%) healthy controls and 32 (59%) patients with MCI. Participants completed a virtual kiosk test to collect 4 VR-derived biomarkers (hand movement speed, scanpath length, time to completion, and the number of errors), and T1-weighted MRI scans were performed to collect 22 MRI biomarkers from both hemispheres. Analyses of covariance were used to compare these biomarkers between healthy controls and patients with MCI, with age considered as a covariate. Subsequently, the biomarkers that exhibited significant differences between the 2 groups were used to train and validate a multimodal learning model aimed at early screening for patients with MCI among healthy controls. Results: The support vector machine (SVM) using only VR-derived biomarkers achieved a sensitivity of 87.5% and specificity of 90%, whereas the MRI biomarkers showed a sensitivity of 90.9% and specificity of 71.4%. Moreover, a correlation analysis revealed a significant association between MRI-observed brain atrophy and impaired performance in instrumental activities of daily living in the VR environment. Notably, the integration of both VR-derived and MRI biomarkers into a multimodal SVM model yielded superior results compared to unimodal SVM models, achieving higher accuracy (94.4%), sensitivity (100%), specificity (90.9%), precision (87.5%), and F1-score (93.3%). Conclusions: The results indicate that VR-derived biomarkers, characterized by their high specificity, can be valuable as a robust, early screening tool for MCI in a broader older adult population. On the other hand, MRI biomarkers, known for their high sensitivity, excel at confirming the presence of MCI. Moreover, the multimodal learning approach introduced in our study provides valuable insights into the improvement of early MCI detection by integrating a diverse set of biomarkers. %M 38631021 %R 10.2196/54538 %U https://www.jmir.org/2024/1/e54538 %U https://doi.org/10.2196/54538 %U http://www.ncbi.nlm.nih.gov/pubmed/38631021 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55132 %T The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study %A Fan,Qiping %A Hoang,Minh-Nguyet %A DuBose,Logan %A Ory,Marcia G %A Vennatt,Jeswin %A Salha,Diana %A Lee,Shinduk %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 3841, qipingfan0403@gmail.com %K evaluation %K usability %K family caregiver %K Alzheimer disease %K dementia %K digital health %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The increasing prevalence of Alzheimer disease and Alzheimer disease–related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. %M 38630527 %R 10.2196/55132 %U https://aging.jmir.org/2024/1/e55132 %U https://doi.org/10.2196/55132 %U http://www.ncbi.nlm.nih.gov/pubmed/38630527 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e52443 %T Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study %A Otaka,Eri %A Osawa,Aiko %A Kato,Kenji %A Obayashi,Yota %A Uehara,Shintaro %A Kamiya,Masaki %A Mizuno,Katsuhiro %A Hashide,Shusei %A Kondo,Izumi %K dementia care %K robotics %K emotion %K facial expression %K expression intensity %K long-term care %K sensory modality %K gerontology %K gerontechnology %D 2024 %7 11.4.2024 %9 %J JMIR Aging %G English %X Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for “happy,” “sad,” “angry,” “surprised,” “scared,” and “disgusted” were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for “happy” was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for “happy” was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care. Trial Registration: UMIN Clinical Trials Registry UMIN000046256; https://tinyurl.com/yw37auan %R 10.2196/52443 %U https://aging.jmir.org/2024/1/e52443 %U https://doi.org/10.2196/52443 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e45978 %T Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study %A Haslam-Larmer,Lynn %A Grigorovich,Alisa %A Shum,Leia %A Bianchi,Andria %A Newman,Kristine %A Iaboni,Andrea %A McMurray,Josephine %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 519 756 8228 ext 5649, jmcmurray@wlu.ca %K remote sensing technologies %K dementia %K real-time location systems %K Fit between Individuals, Tasks, and Technology framework %K FITT framework %K technology implementation %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person’s movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual’s self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit’s HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients’ activity levels. %M 38587884 %R 10.2196/45978 %U https://aging.jmir.org/2024/1/e45978 %U https://doi.org/10.2196/45978 %U http://www.ncbi.nlm.nih.gov/pubmed/38587884 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53489 %T A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study %A Atefi,Golnaz. L %A van Knippenberg,Rosalia J M %A Bartels,Sara Laureen %A Losada-Baltar,Andrés %A Márquez-González,María %A Verhey,Frans R J %A de Vugt,Marjolein E %+ Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, Maastricht, 6229 ET, Netherlands, 31 (0) 43 388 1022, g.atefi@maastrichtuniversity.nl %K acceptance and commitment therapy %K ACT %K psychological flexibility %K behavior change %K theory-guided eHealth %K web-based intervention %K supported self-help %K family caregivers %K dementia %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. Objective: The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. Methods: A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). Results: A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. Conclusions: Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-070499 %M 38574360 %R 10.2196/53489 %U https://aging.jmir.org/2024/1/e53489 %U https://doi.org/10.2196/53489 %U http://www.ncbi.nlm.nih.gov/pubmed/38574360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54168 %T Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach %A McLaren,Jaye E %A Hoang-Gia,Dat %A Dorisca,Eugenia %A Hartz,Stephanie %A Dang,Stuti %A Moo,Lauren %+ New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2000, Jaye.McLaren@va.gov %K Alzheimer disease %K caregiver education %K dementia %K interdisciplinary %K older adults %K virtual resources %K website development %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were “general dementia information,” “activities of daily living,” and “self-care and support.” Most (44/45, 98%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. %M 38573761 %R 10.2196/54168 %U https://formative.jmir.org/2024/1/e54168 %U https://doi.org/10.2196/54168 %U http://www.ncbi.nlm.nih.gov/pubmed/38573761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52652 %T Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study %A Gabb,Victoria Grace %A Blackman,Jonathan %A Morrison,Hamish Duncan %A Biswas,Bijetri %A Li,Haoxuan %A Turner,Nicholas %A Russell,Georgina M %A Greenwood,Rosemary %A Jolly,Amy %A Trender,William %A Hampshire,Adam %A Whone,Alan %A Coulthard,Elizabeth %+ Bristol Medical School, University of Bristol, Bristol Brain Centre, Elgar House, Southmead Road, Bristol, BS10 5NB, United Kingdom, 44 117 456 0700, victoria.gabb@bristol.ac.uk %K feasibility %K sleep %K mild cognitive impairment %K dementia %K Lewy body disease %K Alzheimer disease %K Parkinson %K wearable devices %K research %K mobile phone %K electroencephalography %K accelerometery %K mobile applications %K application %K app %K cognitive %K cognitive impairment %K sleeping %K sleep disturbance %K risk factor %K Alzheimer %K wearable %K wearables %K acceptability %K smart device %D 2024 %7 22.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. Objective: This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. Methods: We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. Results: Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. Conclusions: This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. International Registered Report Identifier (IRRID): DERR1-10.2196/52652 %M 38517469 %R 10.2196/52652 %U https://www.researchprotocols.org/2024/1/e52652 %U https://doi.org/10.2196/52652 %U http://www.ncbi.nlm.nih.gov/pubmed/38517469 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48265 %T Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study %A Mychajliw,Christian %A Holz,Heiko %A Minuth,Nathalie %A Dawidowsky,Kristina %A Eschweiler,Gerhard Wilhelm %A Metzger,Florian Gerhard %A Wortha,Franz %+ Geriatric Center, University Hospital for Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076, Germany, 49 07071 ext 2985358, christian.mychajliw@med.uni-tuebingen.de %K serial reaction time task %K SRTT %K implicit learning %K mobile digital assessments %K cognitive impairment %K neurodegeneration %K tablet-based testing %K mild cognitive impairment %K MCI %K dementia %K Alzheimer %K neuropsychology %K aging %K older individuals %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT). Objective: This study aims to develop and empirically test a digital tablet–based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups. Methods: A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI—diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning. Results: Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=−3.64, SE 0.86; z=−4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=−0.34; SE 0.12; t=−2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%). Conclusions: Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice. %M 38512340 %R 10.2196/48265 %U https://aging.jmir.org/2024/1/e48265 %U https://doi.org/10.2196/48265 %U http://www.ncbi.nlm.nih.gov/pubmed/38512340 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e48292 %T Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review %A Kirby,Pippa %A Lai,Helen %A Horrocks,Sophie %A Harrison,Matthew %A Wilson,Danielle %A Daniels,Sarah %A Calvo,Rafael A %A Sharp,David J %A Alexander,Caroline M %+ UK Dementia Research Institute, Care Research and Technology Centre (UK DRI CR&T), 9th Floor, Sir Michael Uren Hub, White City Campus, Imperial College London, 86 Wood Lane, London, W12 0BZ, United Kingdom, 44 20 7594 9755, h.lai18@imperial.ac.uk %K dementia %K technology %K patient and public involvement and engagement %K co-design %K coproduction %D 2024 %7 4.3.2024 %9 Review %J JMIR Aging %G English %X Background: Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care–related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. Objective: This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. Methods: A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. Results: The search yielded 1694 papers, with 31 (1.83%) being analyzed after screening. Most (21/31, 68%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13%) papers used formal methods for evaluating impact. Conclusions: Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved—researchers, patients, and other stakeholders—can learn how we can best conduct research together. %M 38437014 %R 10.2196/48292 %U https://aging.jmir.org/2024/1/e48292 %U https://doi.org/10.2196/48292 %U http://www.ncbi.nlm.nih.gov/pubmed/38437014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49492 %T Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility %A Zheng,Amy %A Bergh,Marissa %A Patel Murali,Komal %A Sadarangani,Tina %+ New York University Rory Meyers College of Nursing, 433 First Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, msb7677@nyu.edu %K adult day services %K primary health care %K health communication %K dementia %K mobile health %K mHealth %K community-based %K health care %K older adults %K older adult %K chronic condition %K health information %K feasibility %K acceptability %K CareMOBI %K mixed methods design %K caregivers %K caregiver %K care workers %K nurses %K social workers %D 2024 %7 1.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users’ health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. Objective: This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. Methods: A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. Results: A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. Conclusions: The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting. %M 38427418 %R 10.2196/49492 %U https://formative.jmir.org/2024/1/e49492 %U https://doi.org/10.2196/49492 %U http://www.ncbi.nlm.nih.gov/pubmed/38427418 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47196 %T Nutritional Interventions for the Prevention of Cognitive Decline in Patients With Mild Cognitive Impairment and Alzheimer Disease: Protocol for a Network Meta-Analysis of Randomized Controlled Trials %A He,Qian %A Wu,Kevin Chun Hei %A Bennett,Adam N %A Zhang,Jia Yue %A Chan,Kei Hang Katie %+ Department of Electrical Engineering, City University of Hong Kong, 1A-313 To Yuen Building, Hong Kong, 999077, China, 86 34426661, kkhchan@cityu.edu.hk %K network meta-analysis %K cognitive impairment %K Alzheimer disease %K Alzheimer %K neurodegenerative disorders %K geriatric care %K nutritional interventions %K older patient %K geriatric %K cognitive decline %K aging %K older people %K nutrition %K cognitive %K aging %K intervention %K Alzheimer disease %K dementia %K acute confusional senile dementia %K Elder Nutritional Physiological Phenomena %K Nutrition Physiology %K nutrition %K meta-analysis %K meta-analyses %K systematic review %K systematic reviews %D 2024 %7 28.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mild cognitive impairment (MCI) is the stage between cognitive decline due to physiological aging and the severity of decline seen in neurodegenerative disorders like Alzheimer disease (AD), which is among the most prevalent neurodegenerative disorders characterized by cognitive impairment. People with MCI are at increased risk of developing AD. Although MCI and AD are incurable, nutritional interventions can potentially delay or prevent their onset. Consequently, effective interventions used to decelerate or alleviate the progress of cognitive impairment in older people are a significant focus in geriatric care. Given the synergistic effects of nutrition on health, assessing the effectiveness of nutritional supplements or dietary composition in preventing MCI or AD is essential for developing interventional strategies. Objective: Our study aims to assess the effectiveness of various nutritional interventions, including special dietary types, dietary patterns, specific foods, nutritional intake, and nutritional supplements, in preventing cognitive decline among patients diagnosed with MCI or AD. To achieve this, we will use a comprehensive approach, including network meta-analysis, pairwise meta-analysis, and systematic review of randomized controlled trials (RCTs). Methods: The review will follow the Population, Intervention, Comparison, Outcome (PICO) model and the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Two investigators will independently search PubMed electronically. Data extraction will follow the inclusion criteria, and data will be assessed for risk of bias using a revised tool. Additionally, evidence quality will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The outcomes of interest are assessing the cognitive outcomes in patients with MCI or AD. A systematic literature search will be conducted, identifying randomized controlled trials that investigate the impact of these nutritional interventions on cognitive function decline in individuals with MCI and AD. Network meta-analyses (random-effects model) and pairwise meta-analyses will then estimate the relative effectiveness of different nutritional interventions. Results: We included 51 studies, published between 1999 and 2023 (27 studies for AD and 24 studies for MCI) and involving 8420 participants. We completed data extraction for all 51 studies by December 2023. Currently, we are actively engaged in data analysis and manuscript preparation. We plan to finalize the manuscript and publish the comprehensive results by the end of 2024. Conclusions: Our study holds significant clinical relevance given the rising prevalence of AD and the potential influence of nutritional interventions on cognitive function in individuals with MCI and AD. By investigating this relationship, our research aims to inform evidence-based decision-making in the development of prevention strategies for MCI and AD. The outcomes are expected to contribute to the establishment of reliable recommendations for MCI or AD management, providing substantial support in the field. Trial Registration: PROSPERO CRD42022331173; http://tinyurl.com/3snjp7a4 International Registered Report Identifier (IRRID): PRR1-10.2196/47196 %M 38416536 %R 10.2196/47196 %U https://www.researchprotocols.org/2024/1/e47196 %U https://doi.org/10.2196/47196 %U http://www.ncbi.nlm.nih.gov/pubmed/38416536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47739 %T Identifying Functional Status Impairment in People Living With Dementia Through Natural Language Processing of Clinical Documents: Cross-Sectional Study %A Laurentiev,John %A Kim,Dae Hyun %A Mahesri,Mufaddal %A Wang,Kuan-Yuan %A Bessette,Lily G %A York,Cassandra %A Zakoul,Heidi %A Lee,Su Been %A Zhou,Li %A Lin,Kueiyu Joshua %+ Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St. Suite 3030, Boston, MA, 02120, United States, 1 617 278 0930, jklin@bwh.harvard.edu %K activities of daily living %K ADLs %K clinical note %K dementia %K electronic health record %K EHR %K functional impairment %K instrumental activities of daily living %K iADLs %K machine learning %K natural language processing %K NLP %D 2024 %7 13.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Assessment of activities of daily living (ADLs) and instrumental ADLs (iADLs) is key to determining the severity of dementia and care needs among older adults. However, such information is often only documented in free-text clinical notes within the electronic health record and can be challenging to find. Objective: This study aims to develop and validate machine learning models to determine the status of ADL and iADL impairments based on clinical notes. Methods: This cross-sectional study leveraged electronic health record clinical notes from Mass General Brigham’s Research Patient Data Repository linked with Medicare fee-for-service claims data from 2007 to 2017 to identify individuals aged 65 years or older with at least 1 diagnosis of dementia. Notes for encounters both 180 days before and after the first date of dementia diagnosis were randomly sampled. Models were trained and validated using note sentences filtered by expert-curated keywords (filtered cohort) and further evaluated using unfiltered sentences (unfiltered cohort). The model’s performance was compared using area under the receiver operating characteristic curve and area under the precision-recall curve (AUPRC). Results: The study included 10,000 key-term–filtered sentences representing 441 people (n=283, 64.2% women; mean age 82.7, SD 7.9 years) and 1000 unfiltered sentences representing 80 people (n=56, 70% women; mean age 82.8, SD 7.5 years). Area under the receiver operating characteristic curve was high for the best-performing ADL and iADL models on both cohorts (>0.97). For ADL impairment identification, the random forest model achieved the best AUPRC (0.89, 95% CI 0.86-0.91) on the filtered cohort; the support vector machine model achieved the highest AUPRC (0.82, 95% CI 0.75-0.89) for the unfiltered cohort. For iADL impairment, the Bio+Clinical bidirectional encoder representations from transformers (BERT) model had the highest AUPRC (filtered: 0.76, 95% CI 0.68-0.82; unfiltered: 0.58, 95% CI 0.001-1.0). Compared with a keyword-search approach on the unfiltered cohort, machine learning reduced false-positive rates from 4.5% to 0.2% for ADL and 1.8% to 0.1% for iADL. Conclusions: In this study, we demonstrated the ability of machine learning models to accurately identify ADL and iADL impairment based on free-text clinical notes, which could be useful in determining the severity of dementia. %M 38349732 %R 10.2196/47739 %U https://www.jmir.org/2024/1/e47739 %U https://doi.org/10.2196/47739 %U http://www.ncbi.nlm.nih.gov/pubmed/38349732 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53025 %T The #SeePainMoreClearly Phase II Pain in Dementia Social Media Campaign: Implementation and Evaluation Study %A Castillo,Louise I R %A Tran,Vivian %A Brachaniec,Mary %A Chambers,Christine T %A Chessie,Kelly %A Couros,Alec %A LeRuyet,Andre %A LeRuyet,Charmayne %A Thorpe,Lilian %A Williams,Jaime %A Wheelwright,Sara %A Hadjistavropoulos,Thomas %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4457, hadjistt@uregina.ca %K knowledge translation %K Twitter %K older adults %K Facebook %K knowledge mobilization %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Social media platforms have been effective in raising awareness of the underassessment and undertreatment of pain in dementia. Objective: After a successful pilot campaign, we aimed to scale our pain-in-dementia knowledge mobilization pilot initiative (ie, #SeePainMoreClearly) to several social media platforms with the aid of a digital media partner. The goal of the initiative was to increase awareness of the challenges in the assessment and management of pain among people with dementia. A variety of metrics were implemented to evaluate the effort. Through this work, we endeavored to highlight key differences between our pilot initiative (which was a grassroots initiative), focusing largely on Twitter and YouTube, and the current science-media partnership. We also aimed to generate recommendations suitable for other social media campaigns related to health or aging. Methods: Evidence-based information about pain in dementia was summarized into engaging content (eg, videos) tailored to the needs of various knowledge users (eg, health professionals, families, and policy makers). We disseminated information using Facebook (Meta Platforms), Twitter (X Corp), YouTube (Alphabet Inc), Instagram (Meta Platforms), and LinkedIn (LinkedIn Corp) and measured the success of the initiative over a 12-month period (2020 to 2021). The evaluation methods focused on web analytics and questionnaires related to social media content. Knowledge users’ web responses about the initiative and semistructured interviews were analyzed using thematic analysis. Results: During the course of the campaign, >700 posts were shared across all platforms. Web analytics showed that we drew >60,000 users from 82 countries to our resource website. Of the social media platforms used, Facebook was the most effective in reaching knowledge users (ie, over 1,300,000 users). Questionnaire responses from users were favorable; interview responses indicated that the information shared throughout the initiative increased awareness of the problem of pain in dementia and influenced respondent behavior. Conclusions: In this investigation, we demonstrated success in directing knowledge users to a resource website with practical information that health professionals could use in patient care along with pain assessment and management information for caregivers and people living with dementia. The evaluation metrics suggested no considerable differences between our pilot campaign and broader initiative when accounting for the length of time of each initiative. The limitations of large-scale health campaigns were noted, and recommendations were outlined for other researchers aiming to leverage social media as a knowledge mobilization tool. %M 38329793 %R 10.2196/53025 %U https://aging.jmir.org/2024/1/e53025 %U https://doi.org/10.2196/53025 %U http://www.ncbi.nlm.nih.gov/pubmed/38329793 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53853 %T Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial %A Zhao,Sunyan %A Zhang,Jing %A Wan,Haijun %A Tao,Chenjie %A Hu,Meng %A Liang,Wei %A Xu,Zhi %A Xu,Bingguo %A Zhang,Jiaying %A Wang,Guoxin %A Li,Ping %A Lyu,Guangmei %A Gong,Yongling %+ Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, 210006, China, 86 25 52271000 ext 66243, gongyongling26@163.com %K older patients with cancer %K cognitive impairment %K chemobrain %K Chinese medicine %K electroacupuncture %D 2024 %7 8.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older patients with cancer experience cognitive impairment and a series of neurocognitive symptoms known as chemobrain due to chemotherapy. Moreover, older populations are disproportionately affected by chemobrain and heightened negative mental health outcomes after cytotoxic chemical drug therapy. Chinese acupuncture is an emerging therapeutic option for chemotherapy-induced cognitive impairment in older patients with cancer, despite limited supporting evidence. Objective: Our study aims to directly contribute to the existing knowledge of this novel Chinese medicine mode in older patients with cancer enrolled at the Department of Oncology/Chinese Medicine, Nanjing First Hospital, China, thereby establishing the basis for further research. Methods: This study involves a 2-arm, prospective, randomized, assessor-blinded clinical trial in older patients with cancer experiencing chemobrain-related stress and treated with Chinese acupuncture from September 30, 2023, to December 31, 2025. We will enroll 168 older patients with cancer with clinically confirmed chemobrain. These participants will be recruited through screening by oncologists for Chinese acupuncture therapy and evaluation. Electroacupuncture will be performed by a registered practitioner of Chinese medicine. The electroacupuncture intervention will take about 30 minutes every session (2 sessions per week over 8 weeks). For the experimental group, the acupuncture points are mainly on the head, limbs, and abdomen, with a total of 6 pairs of electrically charged needles on the head, while for the control group, the acupuncture points are mainly on the head and limbs, with only 1 pair of electrically charged needles on the head. Results: Eligible participants will be randomized to the control group or the experimental group in 1:1 ratio. The primary outcome of this intervention will be the scores of the Montreal Cognitive Assessment. The secondary outcomes, that is, attentional function and working memory will be determined by the Digit Span Test scores. The quality of life of the patients and multiple functional assessments will also be evaluated. These outcomes will be measured at 2, 4, 6, and 8 weeks after the randomization. Conclusions: This efficacy trial will explore whether Chinese electroacupuncture can prevent chemobrain, alleviate the related symptoms, and improve the quality of life of older patients with cancer who are undergoing or are just going to begin chemotherapy. The safety of this electroacupuncture intervention for such patients will also be evaluated. Data from this study will be used to promote electroacupuncture application in patients undergoing chemotherapy and support the design of further real-world studies. Trial Registration: ClinicalTrials.gov NCT05876988; https://clinicaltrials.gov/ct2/show/NCT05876988 International Registered Report Identifier (IRRID): DERR1-10.2196/53853 %M 38329790 %R 10.2196/53853 %U https://www.researchprotocols.org/2024/1/e53853 %U https://doi.org/10.2196/53853 %U http://www.ncbi.nlm.nih.gov/pubmed/38329790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54299 %T Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App %A Young,Stephanie Ruth %A Dworak,Elizabeth McManus %A Byrne,Greg Joseph %A Jones,Callie Madison %A Yao,Lihua %A Yoshino Benavente,Julia Noelani %A Diaz,Maria Varela %A Curtis,Laura %A Gershon,Richard %A Wolf,Michael %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue 21st Floor, Chicago, IL, 60611-3008, United States, 1 3125033303, stephanieruth.young@northwestern.edu %K cognitive screening %K cognitive %K cognition %K psychometric %K usability %K feasibility %K early detection %K dementia %K Alzheimer’s disease, Alzheimer's %K Alzheimer’s disease and age-related dementia %K mHealth, mobile health apps %K detection %K screening %K mobile health %K mobile phone %K app %K apps %K applications %K applications %K user experience %K smartphone %K smartphones %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians’ ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics’ time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile? Methods: A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items. Results: All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants’ rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants’ abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items. Conclusions: Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia. %M 38324368 %R 10.2196/54299 %U https://formative.jmir.org/2024/1/e54299 %U https://doi.org/10.2196/54299 %U http://www.ncbi.nlm.nih.gov/pubmed/38324368 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e51544 %T The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review %A Bauernschmidt,Dorothee %A Wittmann,Janina %A Hirt,Julian %A Meyer,Gabriele %A Bieber,Anja %+ Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), 06112, Germany, 49 345 557 4427, anja.bieber@uk-halle.de %K implementation success %K implementation outcomes %K counseling %K technology %K dementia %D 2024 %7 25.1.2024 %9 Review %J JMIR Aging %G English %X Background: Implementing technology-based counseling as a complex intervention in dementia care poses challenges such as adaptation to stakeholders’ needs and limited resources. While studies have examined the effectiveness of technology-based counseling, its successful implementation remains largely unexplored. Objective: We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. Methods: We conducted a scoping review and systematically searched CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science Core Collection databases (April 2021) in combination with citation searching and web searching (November 2021). Studies reporting on technology-based counseling interventions for people with dementia or their informal caregivers were included, irrespective of the design. We used the conceptual framework for implementation outcomes to operationalize implementation success and applied the outcomes acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability as categories to inform data extraction. We identified dimensions within the categories and synthesized results narratively and graphically. Results: We included 52 publications reporting on 27 technology-based counseling interventions. The studies were conducted in 9 countries and published between 1993 and 2021. As the design of the included studies varied, the number of participants and the type of data reported varied as well. The intervention programs were heterogeneous and ranged from single counseling interventions (such as helpline services) to counseling as part of a multicomponent program. Telephone, email, videoconferencing, social media (respectively chats), and web-based platforms were used for delivering counseling. We found data on appropriateness for all interventions and data on acceptability for most interventions, describing aspects such as consumer-perceived usefulness and helpfulness of services, as well as satisfaction. Information on the other categories of adoption, feasibility, fidelity, implementation cost, penetration, and sustainability was fragmented. Conclusions: The scope and depth of information on conceptual categories of the implementation success of technology-based counseling for people with dementia and informal caregivers varied. The data only partially covered the concept of implementation success, which highlights the need for a systematic evaluation accompanying the implementation. The application of theoretical approaches for implementation and adherence to the framework for developing and evaluating complex interventions are required to promote the implementation of complex interventions and to comprehensively assess implementation success. Trial Registration: PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245473 %M 38271050 %R 10.2196/51544 %U https://aging.jmir.org/2024/1/e51544 %U https://doi.org/10.2196/51544 %U http://www.ncbi.nlm.nih.gov/pubmed/38271050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46941 %T Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach %A Messina,Anna %A Amati,Rebecca %A Annoni,Anna Maria %A Bano,Beatrice %A Albanese,Emiliano %A Fiordelli,Maddalena %+ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 0782104055, anna.messina@usi.ch %K informal caregivers %K iSupport %K dementia %K digital interventions %K mHealth %K community-based participatory research %K community %K caregiver %K mental distress %K physical distress %K support %K development %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from “lesson” to “chapter” and from “suffering from” dementia to “affected by” dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. %M 38265857 %R 10.2196/46941 %U https://formative.jmir.org/2024/1/e46941 %U https://doi.org/10.2196/46941 %U http://www.ncbi.nlm.nih.gov/pubmed/38265857 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54138 %T Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study %A Zhu,Di %A Al Mahmud,Abdullah %A Liu,Wei %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, VIC 3122, Australia, 61 392143830, aalmahmud@swin.edu.au %K co-design %K digital storytelling %K people with mild cognitive impairment %K MCI %K technology-based intervention development %K dementia %K mobile phone %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Community-based social participation has shown promise in delaying cognitive decline in older adults with mild cognitive impairment (MCI) who are at risk of developing dementia. Although group storytelling interventions have proven effective, the need for a skilled workforce to support people with MCI can limit broader community implementation. Technology-based interventions may offer a solution to this limitation by replicating the abilities of therapists. Objective: This study aims to co-design a digital storytelling intervention and evaluate its usability. Methods: This co-design process involved 3 stages, engaging people with MCI (n=12), their caregivers (n=4), and therapists (n=5) in Beijing, China. In the first stage, we used card sorting and voting methods to identify potential incentives for social participation and target the specific abilities that people with MCI wanted to enhance. In the second stage, we conducted brainstorming sessions with people with MCI and their caregivers to identify the potential features of a digital storytelling application named Huiyou (“meeting new friends” in Chinese). Finally, we assessed Huiyou’s usability with people with MCI and therapists, leading to iterative improvements based on the usability findings. Results: We uncovered a crucial link between boosting the self-confidence of people with MCI and their ability to address social participation challenges. Notably, we identified memory improvement and enhanced language expression as key factors for effective communication with grandchildren. Subsequently, participants suggested features and interfaces to address these challenges, leading to the development of Huiyou, a group-based digital storytelling application featuring functions such as generating story materials, conducting memory retrieval activities, and sharing stories. It received an “excellent” rating in the User Experience Questionnaire benchmark, displaying high levels of attractiveness, dependability, stimulation, and novelty. People with MCI achieved an average task completion rate of 87% (n=19; SD 0.13) of the 22 tasks. However, feedback from people with MCI and therapists highlighted usability issues in navigation, activity management, user interface, and feature optimization, indicating a need for improved accessibility and efficiency. Conclusions: The co-design approach contributed to developing the Huiyou prototype, supporting community-based social participation. User feedback highlighted the potential of Huiyou to enhance well-being and facilitate meaningful social interactions while maintaining crucial existing relationships. %M 38231541 %R 10.2196/54138 %U https://aging.jmir.org/2024/1/e54138 %U https://doi.org/10.2196/54138 %U http://www.ncbi.nlm.nih.gov/pubmed/38231541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51732 %T Enabling Personalization for Digital Cognitive Stimulation to Support Communication With People With Dementia: Pilot Intervention Study as a Prelude to AI Development %A Hird,Nick %A Osaki,Tohmi %A Ghosh,Samik %A Palaniappan,Sucheendra K %A Maeda,Kiyoshi %+ Aikomi Ltd Co, Yokohama Blue Avenue 12th Floor, 4-4-2 Minatomirai, Yokohama, Kanagawa, 220-0012, Japan, 81 70 4538 2854, nick.hird@aikomi.co.jp %K dementia %K digital technology %K communication %K engagement %K cognitive stimulation %K artificial intelligence %K AI %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining good communication and engagement between people with dementia and their caregivers is a major challenge in dementia care. Cognitive stimulation is a psychosocial intervention that supports communication and engagement, and several digital applications for cognitive stimulation have been developed. Personalization is an important factor for obtaining sustainable benefits, but the time and effort required to personalize and optimize applications often makes them difficult for routine use by nonspecialist caregivers and families. Although artificial intelligence (AI) has great potential to support automation of the personalization process, its use is largely unexplored because of the lack of suitable data from which to develop and train machine learning models. Objective: This pilot study aims to evaluate a digital application called Aikomi in Japanese care homes for its potential to (1) create and deliver personalized cognitive stimulation programs to promote communication and engagement between people with dementia and usual care staff and (2) capture meaningful personalized data suitable for the development of AI systems. Methods: A modular technology platform was developed and used to create personalized programs for 15 people with dementia living in 4 residential care facilities in Japan with the cooperation of a family member or care staff. A single intervention with the program was conducted with the person with dementia together with a care staff member, and for some participants, smell stimulation was provided using selected smell sticks in conjunction with the digital program. All sessions were recorded using a video camera, and the combined personalized data obtained by the platform were analyzed. Results: Most people with dementia (10/15, 67%) showed high levels of engagement (>40 on Engagement of a Person with Dementia Scale), and there were no incidences of negative reactions toward the programs. Care staff reported that some participants showed extended concentration and spontaneous communication while using Aikomi, which was not their usual behavior. Smell stimulation promoted engagement for some participants even when they were unable to identify the smell. No changes in well-being were observed following the intervention according to the Mental Function Impairment Scale. The level of response to each type of content in the stimulation program varied greatly according to the person with dementia, and personalized data captured by the Aikomi platform enabled understanding of correlations between stimulation content and responses for each participant. Conclusions: This study suggests that the Aikomi digital application is acceptable for use by persons with dementia and care staff and may have the potential to promote communication and engagement. The platform captures personalized data, which can provide suitable input for machine learning. Further investigation of Aikomi will be conducted to develop AI systems and create personalized digital cognitive stimulation applications that can be easily used by nonspecialist caregivers. %M 38227357 %R 10.2196/51732 %U https://formative.jmir.org/2024/1/e51732 %U https://doi.org/10.2196/51732 %U http://www.ncbi.nlm.nih.gov/pubmed/38227357 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53671 %T Refining Cultural Adaptations of a Behavioral Intervention for Latino Caregivers of People Living With Dementia: Qualitative Interview Study in Washington State %A Garcia,Celeste N %A Duran,Miriana C %A Ramirez,Magaly %+ Department of Health Systems and Population Health, University of Washington, 3980 15th Avenue North East, Seattle, WA, 98195, United States, 1 2065439773, maggiera@uw.edu %K caregivers %K caregiver %K caregiving %K carer %K carers %K STAR-C %K STAR caregiver %K internet %K web-based %K online %K educational %K education %K family care %K family %K families %K informal care %K adaptation %K adaptations %K cultural %K culturally %K module %K modules %K training %K Hispanic %K Hispanics %K Spanish %K Latin %K Latina %K Latinas %K Latinos %K Latinx %K Latino %K dementia %K qualitative research %K Alzheimer disease %K qualitative %K Alzheimer %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K aging %K older adults %K old age %K mental health %K neuro %K ageing %K geriatrics %K gerontology %K geriatric %K interview %K eHealth %K digital health %K alzheimers %K memory %K memory loss %K care giving %K Hispanic or Latino %K mobile phone %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Aging %G English %X Background:  In the United States, Latino caregivers of individuals with dementia face unique challenges and an elevated risk of adverse health outcomes. Despite the increasing prevalence of Alzheimer disease and related dementias among Latino adults, few evidence-based interventions are tailored to their cultural context. To address this gap, we examined the cultural adaptations required for the STAR caregivers (STAR-C) virtual intervention, an evidence-based intervention that educates family caregivers to manage behavioral and psychological symptoms of dementia. While STAR-C has shown effectiveness, neither the original in-person nor the virtual intervention considered the distinct experiences of Latino caregivers, who often bring culturally significant values into caregiving interactions. Objective: This study’s objective was to test and refine the preliminary cultural adaptations of the STAR-C web-based training modules for Latino caregivers of people living with dementia. Methods: Through qualitative interviews with 15 Latino caregivers in Washington State, we identified key adaptations to enhance the cultural relevance of the web-based training modules. Results: The interviews highlighted 4 main themes for adaptation: the delivery of the STAR-C web-based training modules, comprehensive dementia education, simplified problem-solving strategies, and prioritizing caregiver well-being. Conclusions: This study’s findings informed the development of culturally adapted STAR-C web-based training modules that aim to provide tailored support to Latino caregivers. While further research is needed to assess the efficacy of these adaptations, our work contributes to bridging the gap in dementia caregiving for Latino families, potentially reducing health disparities and enhancing health care services for this population. %M 38206663 %R 10.2196/53671 %U https://aging.jmir.org/2024/1/e53671 %U https://doi.org/10.2196/53671 %U http://www.ncbi.nlm.nih.gov/pubmed/38206663 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50548 %T Monitoring and Evaluation of Dementia-Friendly Neighborhoods Using a Walkshed Approach: Protocol for a Scoping Review %A Groulx,Mark %A Freeman,Shannon %A Gourlay,Keone %A Hemingway,Dawn %A Rossnagel,Emma %A Chaudhury,Habib %A Nouri,Mohammadjavad %+ University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada, 1 250 960 5837, mark.groulx@unbc.ca %K dementia-friendly %K neighborhood %K persons living with dementia %K walkability %K walkshed %D 2024 %7 3.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of people in society living with dementia is growing. In Canada, most people who live with dementia live at home, often in a neighborhood setting. Neighborhood environments can be a source of independence, social engagement, and well-being. They can also contain barriers that limit physical activity, social engagement, and well-being. A dementia-friendly neighborhood includes assets that support persons living with dementia and their caregivers in multiple life domains, including those that support walking within the neighborhood environment. Objective: The objectives for this scoping review are twofold. First, focusing on walkshed analysis, we aim to extend scholarly understandings of methodological practices used in the monitoring and evaluation of dementia-friendly neighborhoods. Second, we aim to provide clear and practical guidance for those working in planning, design, and public health fields to assess the neighborhood context in support of evidence-based action to improve the lives of persons living with dementia. Methods: The study design follows Arksey and O’Malley’s scoping review framework and PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. We will conduct a search of peer-reviewed studies in 6 electronic databases to identify the use of Geographic Information System analysis to measure the walkshed of persons living with dementia in a community setting. As age is a primary risk factor associated with dementia, we will also include studies that focus more broadly on community-dwelling older adults aged 65 years and older. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, walkshed analysis methods, and criteria and indicators used to measure dementia-friendly neighborhoods. Results: The results of the study and the submission of a manuscript for peer review are expected in June 2024. The results of the review are expected to contribute to an understanding of methods for monitoring and evaluating dementia-friendly neighborhoods. Expected findings will include a detailed breakdown of current parameters and routines used to conduct walkshed analysis. Findings will also convey criteria that can be operationalized in a Geographic Information System as indicators to assess barriers and facilitators to walking in a neighborhood setting. Conclusions: As far as we are aware, the proposed scoping review will be the first to provide comprehensive methodological or technical guidance for conducting walkshed analysis specific to persons living with dementia. Both the scalability and objective nature of walkshed analysis are likely to be of direct interest to public health practitioners, planners, and allied professionals. Clearly documenting methods used in walkshed analysis can spur increased collaboration across these disciplines to enable an evidence-informed approach to improving neighborhood environments for persons living with dementia. International Registered Report Identifier (IRRID): PRR1-10.2196/50548 %M 38170573 %R 10.2196/50548 %U https://www.researchprotocols.org/2024/1/e50548 %U https://doi.org/10.2196/50548 %U http://www.ncbi.nlm.nih.gov/pubmed/38170573 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51501 %T Text Dialogue Analysis for Primary Screening of Mild Cognitive Impairment: Development and Validation Study %A Wang,Changyu %A Liu,Siru %A Li,Aiqing %A Liu,Jialin %+ Information Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang28 85422306, Chengdu, 610041, China, 86 28 85422306, DLJL8@163.com %K artificial intelligence %K AI %K AI models %K ChatGPT %K primary screening %K mild cognitive impairment %K standardization %K prompt design %K design %K artificial intelligence %K cognitive impairment %K screening %K model %K clinician %K diagnosis %D 2023 %7 29.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence models tailored to diagnose cognitive impairment have shown excellent results. However, it is unclear whether large linguistic models can rival specialized models by text alone. Objective: In this study, we explored the performance of ChatGPT for primary screening of mild cognitive impairment (MCI) and standardized the design steps and components of the prompts. Methods: We gathered a total of 174 participants from the DementiaBank screening and classified 70% of them into the training set and 30% of them into the test set. Only text dialogues were kept. Sentences were cleaned using a macro code, followed by a manual check. The prompt consisted of 5 main parts, including character setting, scoring system setting, indicator setting, output setting, and explanatory information setting. Three dimensions of variables from published studies were included: vocabulary (ie, word frequency and word ratio, phrase frequency and phrase ratio, and lexical complexity), syntax and grammar (ie, syntactic complexity and grammatical components), and semantics (ie, semantic density and semantic coherence). We used R 4.3.0. for the analysis of variables and diagnostic indicators. Results: Three additional indicators related to the severity of MCI were incorporated into the final prompt for the model. These indicators were effective in discriminating between MCI and cognitively normal participants: tip-of-the-tongue phenomenon (P<.001), difficulty with complex ideas (P<.001), and memory issues (P<.001). The final GPT-4 model achieved a sensitivity of 0.8636, a specificity of 0.9487, and an area under the curve of 0.9062 on the training set; on the test set, the sensitivity, specificity, and area under the curve reached 0.7727, 0.8333, and 0.8030, respectively. Conclusions: ChatGPT was effective in the primary screening of participants with possible MCI. Improved standardization of prompts by clinicians would also improve the performance of the model. It is important to note that ChatGPT is not a substitute for a clinician making a diagnosis. %M 38157230 %R 10.2196/51501 %U https://www.jmir.org/2023/1/e51501 %U https://doi.org/10.2196/51501 %U http://www.ncbi.nlm.nih.gov/pubmed/38157230 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e48031 %T Older Adults’ Engagement and Mood During Robot-Assisted Group Activities in Nursing Homes: Development and Observational Pilot Study %A Tanner,Alexandra %A Urech,Andreas %A Schulze,Hartmut %A Manser,Tanja %+ School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, Switzerland, 41 0796040979, mail@alexandratanner.net %K human-robot interaction %K social robot %K nursing home %K observational research %K group activity %K observational %K pilot study %K robot %K engagement %K mood %K well-being %K cognitive %K elderly %K social robot %K nursing %K aging %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Promoting the well-being of older adults in an aging society requires new solutions. One resource might be the use of social robots for group activities that promote physical and cognitive stimulation. Engaging in a robot-assisted group activity may help in the slowdown of physical and cognitive decline in older adults. Currently, our knowledge is limited on whether older adults engage in group activities with humanlike social robots and whether they experience a positive affect while doing so. Both are necessary preconditions to achieve the intended effects of a group activity. Objective: Our pilot study has 2 aims. First, we aimed to develop and pilot an observational coding scheme for robot-assisted group activities because self-report data on engagement and mood of nursing home residents are often difficult to obtain, and the existing observation instruments do have limitations. Second, we aimed to investigate older adults’ engagement and mood during robot-assisted group activities in 4 different nursing care homes in the German-speaking part of Switzerland. Methods: We developed an observation system, inspired by existing tools, for a structured observation of engagement and mood of older adults during a robot-assisted group activity. In this study, 85 older adult residents from 4 different care homes in Switzerland participated in 5 robot-assisted group activity sessions, and they were observed using our developed system. The data were collected in the form of video clips that were assessed by 2 raters regarding engagement (direction of gaze, posture as well as body expression, and activity) and mood (positive and negative affects). Both variables were rated on a 5-point rating scale. Results: Our pilot study findings show that the engagement and mood of older adults can be assessed reliably by using the proposed observational coding scheme. Most participants actively engaged in robot-assisted group activities (mean 4.19, SD 0.47; median 4.0). The variables used to measure engagement were direction of gaze (mean 4.65, SD 0.49; median 5.0), posture and body expression (mean 4.03, SD 0.71; median 4.0), and activity (mean 3.90, SD 0.65; median 4.0). Further, we observed mainly positive affects in this group. Almost no negative affect was observed (mean 1.13, SD 0.20; median 1.0), while the positive affect (mean 3.22, SD 0.55; median 3.2) was high. Conclusions: The developed observational coding system can be used and further developed in future studies on robot-assisted group activities in the nursing home context and potentially in other settings. Additionally, our pilot study indicates that cognitive and physical stimulation of older adults can be promoted by social robots in a group setting. This finding encourages future technological development and improvement of social robots and points to the potential of observational research to systematically evaluate such developments. %M 38145484 %R 10.2196/48031 %U https://rehab.jmir.org/2023/1/e48031 %U https://doi.org/10.2196/48031 %U http://www.ncbi.nlm.nih.gov/pubmed/38145484 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47487 %T Digital Cognitive Assessment Tests for Older Adults: Systematic Literature Review %A Cubillos,Claudio %A Rienzo,Antonio %+ Escuela de Ingeniería Biomédica, Universidad de Valparaiso, General Cruz 222, Valparaíso, 2362905, Chile, 56 998291207, antonio.rienzo@uv.cl %K cognitive digital test %K systematic review %K cognitive screening %K digital interventions %K older adults %D 2023 %7 8.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The global health pandemic has affected the increasing older adult population, especially those with mental illnesses. It is necessary to prevent cases of cognitive impairment in adults early on, and this requires the support of information and communication technologies for evaluating and training cognitive functions. This can be achieved through computer applications designed for cognitive assessment. Objective: In this review, we aimed to assess the state of the art of the current platforms and digital test applications for cognitive evaluation, with a focus on older adults. Methods: A systematic literature search was conducted on 3 databases (Web of Science, PubMed, and Scopus) to retrieve recent articles on the applications of digital tests for cognitive assessment and analyze them based on the methodology used. Four research questions were considered. Through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, following the application of inclusion and exclusion criteria, a total of 20 articles were finally reviewed. Results: Some gaps and trends were identified regarding the types of digital applications and technologies used, the evaluated effects on cognitive domains, and the psychometric parameters and personal characteristics considered for validation. Conclusions: Computerized tests (similar to paper-and-pencil tests) and test batteries (on computers, tablets, or web platforms) were the predominant types of assessments. Initial studies with simulators, virtual environments, and daily-life activity games were also conducted. Diverse validation methods and psychometric properties were observed; however, there was a lack of evaluations that involved specific populations with diverse education levels, cultures, and degrees of technology acceptance. In addition, these evaluations should consider emotional and usability aspects. %M 38064247 %R 10.2196/47487 %U https://mental.jmir.org/2023/1/e47487 %U https://doi.org/10.2196/47487 %U http://www.ncbi.nlm.nih.gov/pubmed/38064247 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49147 %T A Stable and Scalable Digital Composite Neurocognitive Test for Early Dementia Screening Based on Machine Learning: Model Development and Validation Study %A Gu,Dongmei %A Lv,Xiaozhen %A Shi,Chuan %A Zhang,Tianhong %A Liu,Sha %A Fan,Zili %A Tu,Lihui %A Zhang,Ming %A Zhang,Nan %A Chen,Liming %A Wang,Zhijiang %A Wang,Jing %A Zhang,Ying %A Li,Huizi %A Wang,Luchun %A Zhu,Jiahui %A Zheng,Yaonan %A Wang,Huali %A Yu,Xin %A , %+ Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191, China, 86 10 82801999, yuxin@bjmu.edu.cn %K mild cognitive impairment %K digital cognitive assessment %K machine learning %K neurocognitive test %K cognitive screening %K dementia %D 2023 %7 1.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia has become a major public health concern due to its heavy disease burden. Mild cognitive impairment (MCI) is a transitional stage between healthy aging and dementia. Early identification of MCI is an essential step in dementia prevention. Objective: Based on machine learning (ML) methods, this study aimed to develop and validate a stable and scalable panel of cognitive tests for the early detection of MCI and dementia based on the Chinese Neuropsychological Consensus Battery (CNCB) in the Chinese Neuropsychological Normative Project (CN-NORM) cohort. Methods: CN-NORM was a nationwide, multicenter study conducted in China with 871 participants, including an MCI group (n=327, 37.5%), a dementia group (n=186, 21.4%), and a cognitively normal (CN) group (n=358, 41.1%). We used the following 4 algorithms to select candidate variables: the F-score according to the SelectKBest method, the area under the curve (AUC) from logistic regression (LR), P values from the logit method, and backward stepwise elimination. Different models were constructed after considering the administration duration and complexity of combinations of various tests. Receiver operating characteristic curve and AUC metrics were used to evaluate the discriminative ability of the models via stratified sampling cross-validation and LR and support vector classification (SVC) algorithms. This model was further validated in the Alzheimer’s Disease Neuroimaging Initiative phase 3 (ADNI-3) cohort (N=743), which included 416 (56%) CN subjects, 237 (31.9%) patients with MCI, and 90 (12.1%) patients with dementia. Results: Except for social cognition, all other domains in the CNCB differed between the MCI and CN groups (P<.008). In feature selection results regarding discrimination between the MCI and CN groups, the Hopkins Verbal Learning Test-5 minutes Recall had the best performance, with the highest mean AUC of up to 0.80 (SD 0.02) and an F-score of up to 258.70. The scalability of model 5 (Hopkins Verbal Learning Test-5 minutes Recall and Trail Making Test-B) was the lowest. Model 5 achieved a higher level of discrimination than the Hong Kong Brief Cognitive test score in distinguishing between the MCI and CN groups (P<.05). Model 5 also provided the highest sensitivity of up to 0.82 (range 0.72-0.92) and 0.83 (range 0.75-0.91) according to LR and SVC, respectively. This model yielded a similar robust discriminative performance in the ADNI-3 cohort regarding differentiation between the MCI and CN groups, with a mean AUC of up to 0.81 (SD 0) according to both LR and SVC algorithms. Conclusions: We developed a stable and scalable composite neurocognitive test based on ML that could differentiate not only between patients with MCI and controls but also between patients with different stages of cognitive impairment. This composite neurocognitive test is a feasible and practical digital biomarker that can potentially be used in large-scale cognitive screening and intervention studies. %M 38039074 %R 10.2196/49147 %U https://www.jmir.org/2023/1/e49147 %U https://doi.org/10.2196/49147 %U http://www.ncbi.nlm.nih.gov/pubmed/38039074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48193 %T Examining Online Behaviors of Adult-Child and Spousal Caregivers for People Living With Alzheimer Disease or Related Dementias: Comparative Study in an Open Online Community %A Ni,Congning %A Song,Qingyuan %A Malin,Bradley %A Song,Lijun %A Commiskey,Patricia %A Stratton,Lauren %A Yin,Zhijun %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Nashville, TN, 37203, United States, 1 6159363690, zhijun.yin@vumc.org %K Alzheimer disease or related dementias %K informal caregivers %K adult-child caregivers %K spousal caregivers %K online community %K sentiment analysis %K topic modeling %K text classification %D 2023 %7 17.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Alzheimer disease or related dementias (ADRD) are severe neurological disorders that impair the thinking and memory skills of older adults. Most persons living with dementia receive care at home from their family members or other unpaid informal caregivers; this results in significant mental, physical, and financial challenges for these caregivers. To combat these challenges, many informal ADRD caregivers seek social support in online environments. Although research examining online caregiving discussions is growing, few investigations have distinguished caregivers according to their kin relationships with persons living with dementias. Various studies have suggested that caregivers in different relationships experience distinct caregiving challenges and support needs. Objective: This study aims to examine and compare the online behaviors of adult-child and spousal caregivers, the 2 largest groups of informal ADRD caregivers, in an open online community. Methods: We collected posts from ALZConnected, an online community managed by the Alzheimer’s Association. To gain insights into online behaviors, we first applied structural topic modeling to identify topics and topic prevalence between adult-child and spousal caregivers. Next, we applied VADER (Valence Aware Dictionary for Sentiment Reasoning) and LIWC (Linguistic Inquiry and Word Count) to evaluate sentiment changes in the online posts over time for both types of caregivers. We further built machine learning models to distinguish the posts of each caregiver type and evaluated them in terms of precision, recall, F1-score, and area under the precision-recall curve. Finally, we applied the best prediction model to compare the temporal trend of relationship-predicting capacities in posts between the 2 types of caregivers. Results: Our analysis showed that the number of posts from both types of caregivers followed a long-tailed distribution, indicating that most caregivers in this online community were infrequent users. In comparison with adult-child caregivers, spousal caregivers tended to be more active in the community, publishing more posts and engaging in discussions on a wider range of caregiving topics. Spousal caregivers also exhibited slower growth in positive emotional communication over time. The best machine learning model for predicting adult-child, spousal, or other caregivers achieved an area under the precision-recall curve of 81.3%. The subsequent trend analysis showed that it became more difficult to predict adult-child caregiver posts than spousal caregiver posts over time. This suggests that adult-child and spousal caregivers might gradually shift their discussions from questions that are more directly related to their own experiences and needs to questions that are more general and applicable to other types of caregivers. Conclusions: Our findings suggest that it is important for researchers and community organizers to consider the heterogeneity of caregiving experiences and subsequent online behaviors among different types of caregivers when tailoring online peer support to meet the specific needs of each caregiver group. %M 37976095 %R 10.2196/48193 %U https://www.jmir.org/2023/1/e48193 %U https://doi.org/10.2196/48193 %U http://www.ncbi.nlm.nih.gov/pubmed/37976095 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48912 %T Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial %A Kim,Du-Ri %A Moon,EunSoo %A Shin,Myung-Jun %A Yang,Yeong-Ae %A Park,Jong-Hwan %+ Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea, 82 0512407071, parkj@pusan.ac.kr %K cognitive function %K depression %K middle aged %K virtual reality %K women %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment. Objective: This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool. Methods: We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults’ welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment. Results: A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group. Conclusions: The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment. Trial Registration: UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z %M 37878378 %R 10.2196/48912 %U https://mental.jmir.org/2023/1/e48912 %U https://doi.org/10.2196/48912 %U http://www.ncbi.nlm.nih.gov/pubmed/37878378 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e49319 %T Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study %A Sharma,Nikita %A Braakman-Jansen,Louise M A %A Oinas-Kukkonen,Harri %A Croockewit,Jan Hendrik %A Gemert-Pijnen,JEWC van %+ Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Zilverling, Hallenweg 19,, Enschede, 7522 NH, Netherlands, 31 53 489 9111, n.sharma@utwente.nl %K informal caregiving %K cognitive impairment %K unobtrusive sensing solutions %K in-home care %K aging in place %K assistive technologies %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Aging %G English %X Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. %M 37878353 %R 10.2196/49319 %U https://aging.jmir.org/2023/1/e49319 %U https://doi.org/10.2196/49319 %U http://www.ncbi.nlm.nih.gov/pubmed/37878353 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48143 %T Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis %A Engineer,Margi %A Kot,Sushant %A Dixon,Emma %+ Computer Science Department, Clemson University, 105 Sikes Hall, Clemson, SC, 29634, United States, 1 (864) 656 3311, mengine@g.clemson.edu %K natural language processing %K consumer health information %K readability %K Alzheimer disease and related dementias %K caregivers %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. Objective: In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. Methods: We assessed the text’s readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. Results: The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. Conclusions: Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia. %M 37878351 %R 10.2196/48143 %U https://formative.jmir.org/2023/1/e48143 %U https://doi.org/10.2196/48143 %U http://www.ncbi.nlm.nih.gov/pubmed/37878351 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48093 %T Digital Marker for Early Screening of Mild Cognitive Impairment Through Hand and Eye Movement Analysis in Virtual Reality Using Machine Learning: First Validation Study %A Kim,Se Young %A Park,Jinseok %A Choi,Hojin %A Loeser,Martin %A Ryu,Hokyoung %A Seo,Kyoungwon %+ Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Sangsang hall, 4th Fl., Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul, 01811, Republic of Korea, 82 010 5668 8660, kwseo@seoultech.ac.kr %K Alzheimer disease %K biomarkers %K dementia %K digital markers %K eye movement %K hand movement %K machine learning %K mild cognitive impairment %K screening %K virtual reality %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: With the global rise in Alzheimer disease (AD), early screening for mild cognitive impairment (MCI), which is a preclinical stage of AD, is of paramount importance. Although biomarkers such as cerebrospinal fluid amyloid level and magnetic resonance imaging have been studied, they have limitations, such as high cost and invasiveness. Digital markers to assess cognitive impairment by analyzing behavioral data collected from digital devices in daily life can be a new alternative. In this context, we developed a “virtual kiosk test” for early screening of MCI by analyzing behavioral data collected when using a kiosk in a virtual environment. Objective: We aimed to investigate key behavioral features collected from a virtual kiosk test that could distinguish patients with MCI from healthy controls with high statistical significance. Also, we focused on developing a machine learning model capable of early screening of MCI based on these behavioral features. Methods: A total of 51 participants comprising 20 healthy controls and 31 patients with MCI were recruited by 2 neurologists from a university hospital. The participants performed a virtual kiosk test—developed by our group—where we recorded various behavioral data such as hand and eye movements. Based on these time series data, we computed the following 4 behavioral features: hand movement speed, proportion of fixation duration, time to completion, and the number of errors. To compare these behavioral features between healthy controls and patients with MCI, independent-samples 2-tailed t tests were used. Additionally, we used these behavioral features to train and validate a machine learning model for early screening of patients with MCI from healthy controls. Results: In the virtual kiosk test, all 4 behavioral features showed statistically significant differences between patients with MCI and healthy controls. Compared with healthy controls, patients with MCI had slower hand movement speed (t49=3.45; P=.004), lower proportion of fixation duration (t49=2.69; P=.04), longer time to completion (t49=–3.44; P=.004), and a greater number of errors (t49=–3.77; P=.001). All 4 features were then used to train a support vector machine to distinguish between healthy controls and patients with MCI. Our machine learning model achieved 93.3% accuracy, 100% sensitivity, 83.3% specificity, 90% precision, and 94.7% F1-score. Conclusions: Our research preliminarily suggests that analyzing hand and eye movements in the virtual kiosk test holds potential as a digital marker for early screening of MCI. In contrast to conventional biomarkers, this digital marker in virtual reality is advantageous as it can collect ecologically valid data at an affordable cost and in a short period (5-15 minutes), making it a suitable means for early screening of MCI. We call for further studies to confirm the reliability and validity of this approach. %M 37862101 %R 10.2196/48093 %U https://www.jmir.org/2023/1/e48093 %U https://doi.org/10.2196/48093 %U http://www.ncbi.nlm.nih.gov/pubmed/37862101 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50030 %T The Effects of Exercise on Synaptic Plasticity in Individuals With Mild Cognitive Impairment: Protocol for a Pilot Intervention Study %A Ramdeo,Karishma R %A Fahnestock,Margaret %A Gibala,Martin %A Selvaganapathy,Ponnambalam Ravi %A Lee,Justin %A Nelson,Aimee Jennifer %+ Department of Kinesiology, McMaster University, 1280 Main Street W, Hamilton, ON, L8S4L8, Canada, 1 905 525 9140, nelsonaj@mcmaster.ca %K mild cognitive impairment %K exercise %K brain-derived neurotrophic factor %K cognition %K brain plasticity %K repetitive transcranial magnetic stimulation %K transcranial magnetic stimulation %K magnetic stimulation %K aging %K interval training %K intermittent theta-burst stimulation %K repetitive transcranial magnetic stimulation %K ageing %K gerontology %K geriatric %K cognitive %K physical activity %K fitness %K neurology %K neuroscience %K synapse %K synaptic %K plasticity %K brain %K neurotrophic %K hormone %K hormones %K endocrinology %D 2023 %7 18.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mild cognitive impairment (MCI) is a syndrome preceding more severe impairment characterized by dementia. MCI affects an estimated 15% to 20% of people older than 65 years. Nonpharmacological interventions including exercise are recommended as part of overall MCI management based on the positive effects of exercise on cognitive performance. Interval training involves brief intermittent bouts of exercise interspersed with short recovery periods. This type of exercise promotes cognitive improvement and can be performed in individuals with MCI. Synaptic plasticity can be assessed in vivo by the neurophysiological response to repetitive transcranial magnetic stimulation (rTMS). A method to assess synaptic plasticity uses an intermittent theta burst stimulation (iTBS), which is a patterned form of rTMS. Individuals with MCI have decreased responses to iTBS, reflecting reduced synaptic plasticity. It is unknown whether interval training causes changes in synaptic plasticity in individuals living with MCI. Objective: This research will determine whether interval training performed using a cycle ergometer enhances synaptic plasticity in individuals with MCI. The three aims are to (1) quantify synaptic plasticity after interval training performed at a self-determined intensity in individuals with MCI; (2) determine whether changes in synaptic plasticity correlate with changes in serum brain-derived neurotrophic factor, osteocalcin, and cognition; and (3) assess participant compliance to the exercise schedule. Methods: 24 individuals diagnosed with MCI will be recruited for assignment to 1 of the 2 equally sized groups: exercise and no exercise. The exercise group will perform exercise 3 times per week for 4 weeks. Synaptic plasticity will be measured before and following the 4-week intervention. At these time points, synaptic plasticity will be measured as the response to single-pulse TMS, reflected as the percent change in the average amplitude of 20 motor-evoked potentials before and after an iTBS rTMS protocol, which is used to induce synaptic plasticity. In addition, individuals will complete a battery of cognitive assessments and provide a blood sample from the antecubital vein to determine serum brain-derived neurotrophic factor and osteocalcin. Results: The study began in September 2023. Conclusions: The proposed research is the first to assess whether synaptic plasticity is enhanced after exercise training in individuals with MCI. If exercise does indeed modify synaptic plasticity, this will create a new avenue by which we can study and manipulate neural plasticity in these individuals. Trial Registration: ClinicalTrials.gov NCT05663918; https://clinicaltrials.gov/study/NCT05663918 International Registered Report Identifier (IRRID): PRR1-10.2196/50030 %M 37851488 %R 10.2196/50030 %U https://www.researchprotocols.org/2023/1/e50030 %U https://doi.org/10.2196/50030 %U http://www.ncbi.nlm.nih.gov/pubmed/37851488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46188 %T Researched Apps Used in Dementia Care for People Living With Dementia and Their Informal Caregivers: Systematic Review on App Features, Security, and Usability %A Ye,Bing %A Chu,Charlene H %A Bayat,Sayeh %A Babineau,Jessica %A How,Tuck-Voon %A Mihailidis,Alex %+ Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada, 1 416 597 3422 ext 7910, bing.ye@utoronto.ca %K mobile technologies %K mobile apps %K dementia %K privacy %K security %K usability testing %K informal caregivers %K mobile phone %D 2023 %7 12.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care. Objective: This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security. Methods: ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim. Results: Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia. Conclusions: The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps. Trial Registration: PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141 International Registered Report Identifier (IRRID): RR2-10.1159/000514838 %M 37824187 %R 10.2196/46188 %U https://www.jmir.org/2023/1/e46188 %U https://doi.org/10.2196/46188 %U http://www.ncbi.nlm.nih.gov/pubmed/37824187 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e45876 %T Differences in Life Space Activity Patterns Between Older Adults With Mild Cognitive Impairment Living Alone or as a Couple: Cohort Study Using Passive Activity Sensing %A Muurling,Marijn %A Au-Yeung,Wan-Tai M %A Beattie,Zachary %A Wu,Chao-Yi %A Dodge,Hiroko %A Rodrigues,Nathaniel K %A Gothard,Sarah %A Silbert,Lisa C %A Barnes,Lisa L %A Steele,Joel S %A Kaye,Jeffrey %+ Department of Neurology, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC locatie VUmc, De Boelelaan 1118, Amsterdam, 1081HZ, Netherlands, 31 (0)204448527, m.muurling@amsterdamumc.nl %K passive monitoring %K in-home sensor %K mild cognitive impairment %K 2-person home %K life space activity %K sensor %K older adult %K aging %K elder %K gerontology %K geriatric %K cognition %K cognitive impairment %K activity pattern %K at home %K daily activities %K activities of daily living %K digital health %K old age %K technology %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Measuring function with passive in-home sensors has the advantages of real-world, objective, continuous, and unobtrusive measurement. However, previous studies have focused on 1-person homes only, which limits their generalizability. Objective: This study aimed to compare the life space activity patterns of participants living alone with those of participants living as a couple and to compare people with mild cognitive impairment (MCI) with cognitively normal participants in both 1- and 2-person homes. Methods: Passive infrared motion sensors and door contact sensors were installed in 1- and 2-person homes with cognitively normal residents or residents with MCI. A home was classified as an MCI home if at least 1 person in the home had MCI. Time out of home (TOOH), independent life space activity (ILSA), and use of the living room, kitchen, bathroom, and bedroom were calculated. Data were analyzed using the following methods: (1) daily averages over 4 weeks, (2) hourly averages (time of day) over 4 weeks, or (3) longitudinal day-to-day changes. Results: In total, 129 homes with people living alone (n=27, 20.9%, MCI and n=102, 79.1%, no-MCI homes) and 52 homes with people living as a couple (n=24, 46.2%, MCI and n=28, 53.8%, no-MCI homes) were included with a mean follow-up of 719 (SD 308) days. Using all 3 analysis methods, we found that 2-person homes showed a shorter TOOH, a longer ILSA, and shorter living room and kitchen use. In MCI homes, ILSA was higher in 2-person homes but lower in 1-person homes. The effects of MCI status on other outcomes were only found when using the hourly averages or longitudinal day-to-day changes over time, and they depended on the household type (alone vs residing as a couple). Conclusions: This study shows that in-home behavior is different when a participant is living alone compared to when they are living as a couple, meaning that the household type should be considered when studying in-home behavior. The effects of MCI status can be detected with in-home sensors, even in 2-person homes, but data should be analyzed on an hour-to-hour basis or longitudinally. %M 37819694 %R 10.2196/45876 %U https://aging.jmir.org/2023/1/e45876 %U https://doi.org/10.2196/45876 %U http://www.ncbi.nlm.nih.gov/pubmed/37819694 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e46483 %T Lexical Speech Features of Spontaneous Speech in Older Persons With and Without Cognitive Impairment: Reliability Analysis %A Hamrick,Phillip %A Sanborn,Victoria %A Ostrand,Rachel %A Gunstad,John %K Alzheimer’s disease %K cognitive dysfunction %K early diagnosis %K psychometrics %K speech %K technology assessment %D 2023 %7 10.10.2023 %9 %J JMIR Aging %G English %X Background: Speech analysis data are promising digital biomarkers for the early detection of Alzheimer disease. However, despite its importance, very few studies in this area have examined whether older adults produce spontaneous speech with characteristics that are sufficiently consistent to be used as proxy markers of cognitive status. Objective: This preliminary study seeks to investigate consistency across lexical characteristics of speech in older adults with and without cognitive impairment. Methods: A total of 39 older adults from a larger, ongoing study (age: mean 81.1, SD 5.9 years) were included. Participants completed neuropsychological testing and both picture description tasks and expository tasks to elicit speech. Participants with T-scores of ≤40 on ≥2 cognitive tests were categorized as having mild cognitive impairment (MCI). Speech features were computed automatically by using Python and the Natural Language Toolkit. Results: Reliability indices based on mean correlations for picture description tasks and expository tasks were similar in persons with and without MCI (with r ranging from 0.49 to 0.65 within tasks). Intraindividual variability was generally preserved across lexical speech features. Speech rate and filler rate were the most consistent indices for the cognitively intact group, and speech rate was the most consistent for the MCI group. Conclusions: Our findings suggest that automatically calculated lexical properties of speech are consistent in older adults with varying levels of cognitive impairment. These findings encourage further investigation of the utility of speech analysis and other digital biomarkers for monitoring cognitive status over time. %R 10.2196/46483 %U https://aging.jmir.org/2023/1/e46483 %U https://doi.org/10.2196/46483 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e45539 %T The Application of Fully Immersive Virtual Reality on Reminiscence Interventions for Older Adults: Scoping Review %A Lu,Zhipeng %A Wang,Wenjin %A Yan,Wei %A Kew,Chung Lin %A Seo,Jinsil Hwaryoung %A Ory,Marcia %+ Department of Architecture, Texas A&M University, 3137 TAMU, College Station, TX, 77845, United States, 1 9798456183, luzhipeng@live.com %K older adults %K fully immersive virtual reality %K reminiscence %K Alzheimer %K cognitive function %K mental health %K psychological well-being %K memory care %K dementia %K scoping review %D 2023 %7 6.10.2023 %9 Review %J JMIR Serious Games %G English %X Background: The increasing number of older adults with mental, behavioral, and memory challenges presents significant public health concerns. Reminiscence is one type of nonpharmacological intervention that can effectively evoke memories, stimulate mental activities, and improve psychological well-being in older adults through a series of discussions on previous experiences. Fully immersive virtual reality (FIVR) may be a useful tool for reminiscence interventions because it uses realistic virtual environments connected to a person’s significant past stories. Objective: This review aims to examine empirical evidence regarding the application of FIVR in reminiscence interventions, its usability and acceptability, and its effectiveness in assisting the intervention to achieve optimal outcomes. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach for scoping reviews. The PubMed, PsycINFO, Embase, CINAHL, Web of Science, ACM, and IEEE Xplore electronic databases were used for the search. We included peer-reviewed studies that used FIVR as an assistive tool for reminiscence interventions; were published between January 1, 2000, and August 1, 2022; reported empirical research; involved older adults as participants; and addressed health- and behavior-related outcomes or the feasibility and usability of FIVR. We used Endnote X9 to organize the search results and Microsoft Excel for data extraction and synthesis. Results: Of the 806 articles collected from the databases and other resources, 11 were identified. Most of the studies involved participants aged between 70 and 90 years. Only 1 study did not involve those with cognitive impairments, whereas 3 specifically targeted people living with dementia. The results indicated that FIVR reminiscence interventions enhanced engagement and reduced fatigue. Although some studies have observed positive effects on anxiety, apathy, depression, cognitive functions, and caregiver burden reduction, these findings were inconsistent across other research. In addition, FIVR showed overall usability and acceptability with manageable side effects among older adults across various health conditions during reminiscence sessions. However, 1 study reported adverse feelings among participants, triggered by unpleasant memories evoked by the virtual reality content. Conclusions: The role of FIVR in reminiscence interventions remains nascent, with limited studies evaluating its impacts on older adults. Many of the reviewed studies had notable limitations: small sample sizes, absence of rigorous research design, limited assessment of long-term effects, lack of measures for health and behavior outcomes, and quality of life. Beyond these limitations, this review identified a list of future research directions in 6 categories. On the basis of the review findings, we provide practical recommendations to enhance FIVR reminiscence interventions, covering topics such as virtual reality content, device choice, intervention types, and the role and responsibility of facilitators. %M 37801360 %R 10.2196/45539 %U https://games.jmir.org/2023/1/e45539 %U https://doi.org/10.2196/45539 %U http://www.ncbi.nlm.nih.gov/pubmed/37801360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47319 %T Addressing the Chronic Pain–Early Cognitive Decline Comorbidity Among Older Adults: Protocol for the Active Brains Remote Efficacy Trial %A Vranceanu,Ana-Maria %A Choukas,Nathaniel R %A Rochon,Elizabeth A %A Duarte,Brooke %A Pietrzykowski,Malvina O %A McDermott,Katherine %A Hooker,Julia E %A Kulich,Ronald %A Quiroz,Yakeel T %A Parker,Robert A %A Macklin,Eric A %A Ritchie,Christine %A , %A Mace,Ryan A %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 (617) 432 1000, avranceanu@mgh.harvard.edu %K chronic pain %K cognitive decline %K physical activity %K mind-body therapies %K aged %K telemedicine %K randomized clinical trial %K mobile phone %D 2023 %7 28.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain and early cognitive decline, which are costly to treat and highly prevalent among older adults, commonly co-occur, exacerbate one another over time, and can accelerate the development and progression of Alzheimer disease and related dementias. We developed the first mind-body activity program (Active Brains [AB]) tailored to the needs of older adults with chronic pain and early cognitive decline. Results from our previous study strongly supported the feasibility of conducting AB remotely and provided evidence for improvements in outcomes. Objective: We are conducting a single-blinded, National Institutes of Health stage-2, randomized clinical trial to establish the efficacy of AB versus a time-matched and dose-matched education control (Health Enhancement Program [HEP]) in improving self-reported and objective outcomes of physical, cognitive, and emotional functions in 260 participants. The methodology described in this paper was informed by the lessons learned from the first year of the trial. Methods: Participants are identified and recruited through multidisciplinary clinician–referred individuals (eg, pain psychologists and geriatricians), the Rally Research platform, social media, and community partnerships. Interested participants complete eligibility screening and electronic informed consent. Baseline assessments include self-report, performance-based measures (eg, 6-min walk test) and objective measures (eg, Repeatable Battery for the Assessment of Neuropsychological Status). Participants are mailed a wrist-worn ActiGraph device (ActiGraph LLC) to passively monitor objective function (eg, steps) during the week between the baseline assessment and the beginning of the programs, which they continue to wear throughout the programs. After baseline assessments, participants are randomized to either AB or HEP and complete 8 weekly, remote, group sessions with a Massachusetts General Hospital psychologist. The AB group receives a Fitbit (Fitbit Inc) to help reinforce increased activity. Assessments are repeated after the intervention and at the 6-month follow-up. Coprimary outcomes include multimodal physical function (self-report, performance based, and objective). Secondary outcomes are cognitive function (self-report and objective), emotional function, and pain. Results: We began recruitment in July 2022 and recruited 37 participants across 4 cohorts. Of them, all (n=37, 100%) have completed the baseline assessment, 26 (70%) have completed the posttest assessment, and 9 (24%) are actively enrolled in the intervention (total dropout: n=2, 5%). In the three cohorts (26/37, 70%) that have completed the AB or HEP, 26 (100%) participants completed all 8 group sessions (including minimal makeups), and watch adherence (1937/2072, 93.48%, average across ActiGraph and Fitbit devices) has been excellent. The fourth cohort is ongoing (9/37, 24%), and we plan to complete enrollment by March 2026. Conclusions: We aim to establish the efficacy of the AB program over a time-matched and dose-matched control in a live video-based trial and test the mechanisms through theoretically driven mediators and moderators. Findings will inform the development of a future multisite effectiveness-implementation trial. Trial Registration: ClinicalTrials.gov NCT05373745; https://classic.clinicaltrials.gov/ct2/show/NCT05373745 International Registered Report Identifier (IRRID): DERR1-10.2196/47319 %M 37768713 %R 10.2196/47319 %U https://www.researchprotocols.org/2023/1/e47319 %U https://doi.org/10.2196/47319 %U http://www.ncbi.nlm.nih.gov/pubmed/37768713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45788 %T Usability Evaluation of a Knowledge Graph–Based Dementia Care Intelligent Recommender System: Mixed Methods Study %A Leng,Minmin %A Sun,Yue %A Li,Ce %A Han,Shuyu %A Wang,Zhiwen %+ School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 15901566817, wzwjing@sina.com %K caregivers %K dementia %K knowledge graph %K recommender system %K usability evaluation %K dementia care intelligent recommender system %K DCIRS %D 2023 %7 26.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Knowledge graph–based recommender systems offer the possibility of meeting the personalized needs of people with dementia and their caregivers. However, the usability of such a recommender system remains unknown. Objective: This study aimed to evaluate the usability of a knowledge graph–based dementia care intelligent recommender system (DCIRS). Methods: We used a convergent mixed methods design to conduct the usability evaluation, including the collection of quantitative and qualitative data. Participants were recruited through social media advertisements. After 2 weeks of DCIRS use, feedback was collected with the Computer System Usability Questionnaire and semistructured interviews. Descriptive statistics were used to describe sociodemographic characteristics and questionnaire scores. Qualitative data were analyzed systematically using inductive thematic analysis. Results: A total of 56 caregivers were recruited. Quantitative data suggested that the DCIRS was easy for caregivers to use, and the mean questionnaire score was 2.14. Qualitative data showed that caregivers generally believed that the content of the DCIRS was professional, easy to understand, and instructive, and could meet users’ personalized needs; they were willing to continue to use it. However, the DCIRS also had some shortcomings. Functions that enable interactions between professionals and caregivers and that provide caregiver support and resource recommendations might be added to improve the system’s usability. Conclusions: The recommender system provides a solution to meet the personalized needs of people with dementia and their caregivers and has the potential to substantially improve health outcomes. The next step will be to optimize and update the recommender system based on caregivers’ suggestions and evaluate the effect of the application. %M 37751241 %R 10.2196/45788 %U https://www.jmir.org/2023/1/e45788 %U https://doi.org/10.2196/45788 %U http://www.ncbi.nlm.nih.gov/pubmed/37751241 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45532 %T A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study %A Bannon,Sarah %A Brewer,Julie %A Ahmad,Nina %A Cornelius,Talea %A Jackson,Jonathan %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Bradford C %A Ritchie,Christine %A Vranceanu,Ana-Maria %+ Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 5 E 98th St, Annex B12, New York, NY, 10029, United States, 1 2122410787, sarah.bannon@mountsinai.org %K dyad %K dementia %K emotional distress %K intervention %K diagnosis %K telehealth %D 2023 %7 20.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners—together called a “dyad.” Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. Objective: This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. Methods: All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. Results: This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. Conclusions: We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. International Registered Report Identifier (IRRID): PRR1-10.2196/45532 %M 37728979 %R 10.2196/45532 %U https://www.researchprotocols.org/2023/1/e45532 %U https://doi.org/10.2196/45532 %U http://www.ncbi.nlm.nih.gov/pubmed/37728979 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49752 %T Reminiscence and Digital Storytelling to Improve the Social and Emotional Well-Being of Older Adults With Alzheimer’s Disease and Related Dementias: Protocol for a Mixed Methods Study Design and a Randomized Controlled Trial %A Xu,Ling %A Fields,Noelle L %A Daniel,Kathryn M %A Cipher,Daisha J %A Troutman,Brooke A %+ School of Social Work, University of Texas at Arlington, 501 W Mitchell Street, Arlington, TX, 76010, United States, 1 817 272 3181, lingxu@uta.edu %K Alzheimer’s disease and related dementias %K ADRD %K digital storytelling %K DST %K intergenerational reminiscence %K older adult %K young adult %K randomized controlled trial %D 2023 %7 7.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increasing attention is being given to the growing concerns about social isolation, loneliness, and compromised emotional well-being experienced by young adults and older individuals affected by Alzheimer disease and related dementias (ADRD). Studies suggest that reminiscence strategies combined with an intergenerational approach may yield significant social and mental health benefits for participants. Experts also recommended the production of a digital life story book as part of reminiscence. Reminiscence is typically implemented by trained professionals (eg, social workers and nurses); however, there has been growing interest in using trained volunteers owing to staffing shortages and the costs associated with reminiscence programs. Objective: The proposed study will develop and test how reminiscence offered by trained young adult volunteers using a digital storytelling platform may help older adults with ADRD to improve their social and emotional well-being. Methods: The proposed project will conduct a randomized controlled trial to assess the effects of the intervention. The older and young adult participants will be randomly assigned to the intervention (reminiscence based) or control groups and then be randomly matched within each group. Data will be collected at baseline before the intervention, in the middle of the intervention, at end of the intervention, and at 3 months after the intervention. An explanatory sequential mixed methods design will be used to take advantage of the strengths of both quantitative and qualitative methods. The quantitative data from surveys will be entered into SPSS and analyzed using covariate-adjusted linear mixed models for repeated measures to compare the intervention and control groups over time on the major outcomes of participants. Conventional content analysis of qualitative interviews will be conducted using data analysis software. Results: The project was modified to a telephone-based intervention owing to the COVID-19 pandemic. Data collection started in 2020 and ended in 2022. In total, 103 dyads were matched at the beginning of the intervention. Of the 103 dyads, 90 (87.4%) dyads completed the midtest survey and 64 (62.1%) dyads completed the whole intervention and the posttest survey. Although we are still cleaning and finalizing data analyses, the preliminary results from both quantitative and qualitative data showed promising results of this intergenerational reminiscence approach that benefits both the older adults who have cognitive impairments and the young adult participants. Conclusions: Intergenerational reminiscence provided by young adult college student offers promising benefits for both the younger and older generations. Future studies may consider scaling up this pilot into a trackable, replicable model that includes more participants with diverse background (eg, public vs private college students and older adults from other agencies) to test the effectiveness of this intervention for older adults with ADRD. Trial Registration: ClinicalTrials.gov NCT05984732; https://classic.clinicaltrials.gov/ct2/show/NCT05984732 International Registered Report Identifier (IRRID): DERR1-10.2196/49752 %M 37676706 %R 10.2196/49752 %U https://www.researchprotocols.org/2023/1/e49752 %U https://doi.org/10.2196/49752 %U http://www.ncbi.nlm.nih.gov/pubmed/37676706 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46269 %T Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study %A Kwok,Ian %A Lattie,Emily Gardiner %A Yang,Dershung %A Summers,Amanda %A Grote,Veronika %A Cotten,Paul %A Moskowitz,Judith Tedlie %+ Northwestern University, Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, United States, 1 323 364 1160, iankwok@u.northwestern.edu %K dementia %K caregiving %K eHealth %K digital interventions %K positive emotion %K stress %K coping %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver’s physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours. Objective: This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members. Methods: Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered. Results: The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72% (SD 42%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants’ willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants’ willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants’ perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants’ sense of social presence may be important for the feasibility and acceptability of the program. Conclusions: In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention. %M 37672311 %R 10.2196/46269 %U https://aging.jmir.org/2023/1/e46269 %U https://doi.org/10.2196/46269 %U http://www.ncbi.nlm.nih.gov/pubmed/37672311 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e47577 %T Financial, Legal, and Functional Challenges of Providing Care for People Living With Dementia and Needs for a Digital Platform: Interview Study Among Family Caregivers %A Fan,Qiping %A DuBose,Logan %A Ory,Marcia G %A Lee,Shinduk %A Hoang,Minh-Nguyet %A Vennatt,Jeswin %A Kew,Chung Lin %A Doyle,David %A Falohun,Tokunbo %+ Department of Public Health Sciences, Clemson University, 524 Edwards Hall, 201 Epsion Zeta Drive, Clemson, SC, 29634, United States, 1 864 656 1622, qipingf@clemson.edu %K family caregiver %K Alzheimer disease %K dementia %K caregiving challenges %K digital health %K community-based participatory research %K mobile phone %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and Alzheimer disease–related dementia represent complex neuropathologies directly challenging individuals, their families, and communities in the United States. To support persons living with dementia, family or informal caregivers often encounter complex financial, psychological, and physical challenges. A widely used solution such as a consolidated web-based assistance or guidance platform is missing, compounding care challenges. Objective: In preparation for designing an internet-based artificial intelligence–driven digital resource platform, a qualitative interview study was conducted to characterize the challenges and needs of family caregivers in the United States. Methods: A semistructured interview topic guide in English was developed by engaging community partners and research partnerships. Family caregiver participants were purposefully recruited via various means, such as word of mouth, local dementia community service providers, digital recruitment emails, flyers, and social media. Interested individuals were first invited to complete an eligibility screening survey, and eligible individuals were then contacted to arrange a web-based in-depth interview via Zoom (Zoom Video Communications) from January 1, 2022, to May 31, 2022. A follow-up survey was administered in May 2022 to provide an overview of the participants’ demographics, socioeconomic characteristics, and caregiving information. Thematic analysis in a framework approach was used to identify and organize themes and the study findings. Results: Following the prescreening of 150 eligible respondents, 20% (30/150) individuals completed both the interviews and follow-up survey, allowing for an in-depth look into the challenges, experiences, and expectations of primary caregivers of people living with dementia. Most participants (20/30, 67%) were primary caregivers of persons with dementia, and 93% (28/30) had provided care for at least a year. Most participants were aged >50 years (25/30, 83%), female (23/30, 77%), White (25/30, 83%), and non-Hispanic (27/30, 90%) and held a bachelor’s or graduate degree (22/30, 73%). Collectively, all participants acknowledged challenges in caring for people living with dementia. Thematic analyses elicited the challenges of caregiving related to functional care needs and financial and legal challenges. In addition, participants identified the need for an integrative digital platform where information could be supplied to foster education, share resources, and provide community support, enabling family caregivers to improve the quality of care and reducing caregiver burden. Conclusions: This study emphasized the difficulties associated with the family caregiver role and the expectations and potential for a supportive web-based platform to mitigate current challenges within the caregiving role. %M 37526513 %R 10.2196/47577 %U https://aging.jmir.org/2023/1/e47577 %U https://doi.org/10.2196/47577 %U http://www.ncbi.nlm.nih.gov/pubmed/37526513 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e45859 %T Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study %A McCrae,Christina S %A Curtis,Ashley F %A Stearns,Melanie A %A Nair,Neetu %A Golzy,Mojgan %A Shenker,Joel I %A Beversdorf,David Q %A Cottle,Amelia %A Rowe,Meredeth A %+ College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL, 33612, United States, 1 813 974 1804, christinamccrae@usf.edu %K arousal %K caregivers %K cognitive behavioral therapy %K CBT: cognitive behavioral therapy for insomnia %K CBT-I %K dementia %K insomnia %K internet %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. Objective: This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES’ content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. Methods: We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. Results: The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention’s comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. Conclusions: Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. Trial Registration: ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628 %M 37616032 %R 10.2196/45859 %U https://aging.jmir.org/2023/1/e45859 %U https://doi.org/10.2196/45859 %U http://www.ncbi.nlm.nih.gov/pubmed/37616032 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46711 %T Key Considerations When Developing and Implementing Digital Technology for Early Detection of Dementia-Causing Diseases Among Health Care Professionals: Qualitative Study %A Wilson,Sarah %A Tolley,Clare %A Mc Ardle,Riona %A Beswick,Emily %A Slight,Sarah P %+ School of Pharmacy, Newcastle University, King George VI building, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 1912082358, sarah.wilson@newcastle.ac.uk %K qualitative %K health care professional %K early detection of disease %K dementia %K digital technology %K early detection of dementia %K digital health %K health care worker %K digital tool %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization (WHO) promotes using digital technologies to accelerate global attainment of health and well-being. This has led to a growth in research exploring the use of digital technology to aid early detection and preventative interventions for dementia-causing diseases such as Alzheimer disease. The opinions and perspectives of health care professionals must be incorporated into the development and implementation of technology to promote its successful adoption in clinical practice. Objective: This study aimed to explore health care professionals’ perspectives on the key considerations of developing and implementing digital technologies for the early detection of dementia-causing diseases in the National Health Service (NHS). Methods: Health care professionals with patient-facing roles in primary or secondary care settings in the NHS were recruited through various web-based NHS clinical networks. Participants were interviewed to explore their experiences of the current dementia diagnostic practices, views on early detection and use of digital technology to aid these practices, and the challenges of implementing such interventions in health care. An inductive thematic analysis approach was applied to identify central concepts and themes in the interviews, allowing the data to determine our themes. A list of central concepts and themes was applied systematically to the whole data set using NVivo (version 1.6.1; QSR International). Using the constant comparison technique, the researchers moved backward and forward between these data and evolving explanations until a fit was made. Results: Eighteen semistructured interviews were conducted, with 11 primary and 7 secondary care health care professionals. We identified 3 main categories of considerations relevant to health care service users, health care professionals, and the digital health technology itself. Health care professionals recognized the potential of using digital technology to collect real-time data and the possible benefits of detecting dementia-causing diseases earlier if an effective intervention were available. However, some were concerned about postdetection management, questioning the point of an early detection of dementia-causing diseases if an effective intervention cannot be provided and feared this would only lead to increased anxiety in patients. Health care professionals also expressed mixed opinions on who should be screened for early detection. Some suggested it should be available to everyone to mitigate the chance of excluding those who are not in touch with their health care or are digitally excluded. Others were concerned about the resources that would be required to make the technology available to everyone. Conclusions: This study highlights the need to design digital health technology in a way that is accessible to all and does not add burden to health care professionals. Further work is needed to ensure inclusive strategies are used in digital research to promote health equity. %M 37606986 %R 10.2196/46711 %U https://www.jmir.org/2023/1/e46711 %U https://doi.org/10.2196/46711 %U http://www.ncbi.nlm.nih.gov/pubmed/37606986 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e46480 %T A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study %A Krafft,Jelena %A Barisch-Fritz,Bettina %A Krell-Roesch,Janina %A Trautwein,Sandra %A Scharpf,Andrea %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 ext 48513, jelena.krafft@kit.edu %K dementia %K individualized physical exercise %K tailored exercise %K physical activity %K older adults %K app %K mobile health %K mHealth %K usability %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as “good.” The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. %M 37606974 %R 10.2196/46480 %U https://aging.jmir.org/2023/1/e46480 %U https://doi.org/10.2196/46480 %U http://www.ncbi.nlm.nih.gov/pubmed/37606974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42561 %T Qualitative Evaluation of Family Caregivers’ Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality %A Meyer,Kylie %A Gonzalez,Alexander %A Benton,Donna %+ Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, United States, 1 216 368 1928, knm77@case.edu %K aging %K Alzheimer’s %K Alzheimer %K caregiver %K caregiving %K dementia: digital health %K digital intervention %K family care %K informal care %K intervention %K older adult %K quality of care %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships. Objective: The purpose of this study is to describe caregivers’ experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing. Methods: Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis. Results: Our findings indicate that caregivers were overall satisfied with KINDER’s focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program’s multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion. Conclusions: Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers’ comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities. %M 37606980 %R 10.2196/42561 %U https://formative.jmir.org/2023/1/e42561 %U https://doi.org/10.2196/42561 %U http://www.ncbi.nlm.nih.gov/pubmed/37606980 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49933 %T Epidemiology of Motoric Cognitive Risk Syndrome in the Kerala Einstein Study: Protocol for a Prospective Cohort Study %A Sathyan,Sanish %A Ayers,Emmeline %A Blumen,Helena %A Weiss,Erica F %A Adhikari,Dristi %A Stimmel,Marnina %A Abdulsalam,Kizhakkaniyakath %A Noone,Mohan %A George,Roy K %A Ceide,Mirnova %A Ambrose,Anne Felicia %A Wang,Cuiling %A Narayanan,Poornima %A Sureshbabu,Sachin %A Shaji,Kunnukatil S %A Sigamani,Alben %A Mathuranath,Pavagada S %A Pradeep,Vayyattu G %A Verghese,Joe %+ Department of Neurology, Albert Einstein College of Medicine, 1225 Morris Park Avenue, Bronx, NY, 10461, United States, 1 7184303877, joe.verghese@einsteinmed.edu %K motoric cognitive risk %K Kerala %K India %K dementia %K cognitive decline %K neuroimaging %D 2023 %7 17.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective: The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study design and procedures for this KES project. Methods: KES is proposing to enroll a sample of 1000 adults ≥60 years old from urban and rural areas in the Kozhikode district of Kerala state: 200 recruited in the previous phase of KES and 800 new participants to be recruited in this project. MCR is the cognitive phenotype of primary interest. The associations between previously established risk factors for dementia as well as novel risk factors (apathy and traumatic brain injury) and MCR will be examined in KES. Risk factor profiles for MCR will be compared between urban and rural residents as well as with individuals who meet the criteria for mild cognitive impairment (MCI). Cognitive and physical function, medical history and medications, sociodemographic characteristics, lifestyle patterns, and activities of daily living will be evaluated. Participants will also undergo magnetic resonance imaging and electrocardiogram investigations. Longitudinal follow-up is planned in a subset of participants as a prelude to future longitudinal studies. Results: KES (2R01AG039330-07) was funded by the US National Institutes of Health in September 2019 and received approval from the Indian Medical Council of Research to start the study in June 2021. We had recruited 433 new participants from urban and rural sites in Kozhikode as of May 2023: 41.1% (178/433) women, 67.7% (293/433) rural residents, and 13.4% (58/433) MCR cases. Enrollment is actively ongoing at all the KES recruitment sites. Conclusions: KES will provide new insights into risk factors and brain substrates associated with MCR in India and will help guide future development of regionally specific preventive interventions for dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/49933 %M 37590054 %R 10.2196/49933 %U https://www.researchprotocols.org/2023/1/e49933 %U https://doi.org/10.2196/49933 %U http://www.ncbi.nlm.nih.gov/pubmed/37590054 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50231 %T Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis %A Powell,Kimberly R %A Popescu,Mihail %A Lee,Suhwon %A Mehr,David R %A Alexander,Gregory L %+ Sinclair School of Nursing, University of Missouri, 915 Hitt Street, Columbia, MO, 65211, United States, 1 5026407556, powellk@missouri.edu %K age-friendly health systems %K Alzheimer disease %K communication %K dementia %K nursing homes %K older adults %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reducing avoidable nursing home (NH)–to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)–funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 %M 37556199 %R 10.2196/50231 %U https://www.researchprotocols.org/2023/1/e50231 %U https://doi.org/10.2196/50231 %U http://www.ncbi.nlm.nih.gov/pubmed/37556199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44125 %T Potential Facilitators of and Barriers to Implementing the MINI Robot in Community-Based Meeting Centers for People With Dementia and Their Carers in the Netherlands and Spain: Explorative Qualitative Study %A Mahmoudi Asl,Aysan %A Kouters,Suzanne %A Castro-González,Álvaro %A Van der Roest,Henriëtte %A Franco Martin,Manuel %A Dröes,Rose-Marie %+ Psycho-Sciences Research Group of the Biomedical Research Institute of Salamanca, Salamanca University, Paseo de San Vicente, 58-182, Salamanca, Spain, 34 923 09 04 70, aysanmd@usal.es %K dementia %K meeting centers %K mild cognitive impairment %K social robots %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social robots, as a form of digital health technologies, are used to support emotional, cognitive, and physical care and have shown promising outcomes in enhancing social well-being in people with dementia (PwD) by boosting emotions, social interactions, and activity participation. Objective: The goal is to investigate the attitude of stakeholders and potential facilitators and the barriers to implementing the social robot MINI in community-based meeting centers (MCs) for PwD and carers in the Netherlands and Spain. Methods: Based on the British Medical Research Council guidance for process evaluation of the implementation of complex interventions and the model for tracing the facilitators of and barriers to the adaptive implementation of innovations in dementia care, an explorative qualitative study was conducted. Following the introduction of the MINI robot, 11 stakeholders were interviewed in 3 MCs in the Netherlands and 1 in Spain, as well as stakeholders in health and welfare organizations in both countries. In addition, 12 adults with dementia participated in focus groups. The data were thematically analyzed and narratively described. Results: Overall, the stakeholder opinion and interest in the MINI robot were positive. The most important (expected) facilitating factors mentioned by stakeholders appeared to be human resources, funding, the impact of the MINI robot on the users and programs of the MCs, characteristics of the innovation, and collaboration with other care and welfare organizations. However, the (expected) barriers mentioned concerned the physical context and functionalities of the MINI robot, the user context, and MC activity policies. Conclusions: The findings will inform professional stakeholders, such as MC directors and managers, as well as care and welfare organizations, on the practicality of using the MINI robot in MCs. Furthermore, our research will aid MINI robot developers in tailoring its features to PwD’s preferences and demands and MC policies, which will contribute to the MINI robot’s effective adoption and deployment. %M 37531190 %R 10.2196/44125 %U https://www.jmir.org/2023/1/e44125 %U https://doi.org/10.2196/44125 %U http://www.ncbi.nlm.nih.gov/pubmed/37531190 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 2 %N %P e46021 %T A Semantic Relatedness Model for the Automatic Cluster Analysis of Phonematic and Semantic Verbal Fluency Tasks Performed by People With Parkinson Disease: Prospective Multicenter Study %A Hähnel,Tom %A Feige,Tim %A Kunze,Julia %A Epler,Andrea %A Frank,Anika %A Bendig,Jonas %A Schnalke,Nils %A Wolz,Martin %A Themann,Peter %A Falkenburger,Björn %+ Department of Neurology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 351 458 ext 11880, tom.haehnel@uniklinikum-dresden.de %K cognition %K executive function %K language function %K mild cognitive impairment %K Parkinson disease %K Parkinson disease dementia %K semantic clusters %K semantic relatedness %K verbal fluency tasks %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Neurotech %G English %X Background: Phonematic and semantic verbal fluency tasks (VFTs) are widely used to capture cognitive deficits in people with neurodegenerative diseases. Counting the total number of words produced within a given time frame constitutes the most commonly used analysis for VFTs. The analysis of semantic and phonematic word clusters can provide additional information about frontal and temporal cognitive functions. Traditionally, clusters in the semantic VFT are identified using fixed word lists, which need to be created manually, lack standardization, and are language specific. Furthermore, it is not possible to identify semantic clusters in the phonematic VFT using this technique. Objective: The objective of this study was to develop a method for the automated analysis of semantically related word clusters for semantic and phonematic VFTs. Furthermore, we aimed to explore the cognitive domains captured by this analysis for people with Parkinson disease (PD). Methods: People with PD performed tablet-based semantic (51/85, 60%) and phonematic (69/85, 81%) VFTs. For both tasks, semantic word clusters were determined using a semantic relatedness model based on a neural network trained on the Wikipedia (Wikimedia Foundation) text corpus. The cluster characteristics derived from this model were compared with those derived from traditional evaluation methods of VFTs and a set of neuropsychological parameters. Results: For the semantic VFT, the cluster characteristics obtained through automated analyses showed good correlations with the cluster characteristics obtained through the traditional method. Cluster characteristics from automated analyses of phonematic and semantic VFTs correlated with the overall cognitive function reported by the Montreal Cognitive Assessment, executive function reported by the Frontal Assessment Battery and the Trail Making Test, and language function reported by the Boston Naming Test. Conclusions: Our study demonstrated the feasibility of standardized automated cluster analyses of VFTs using semantic relatedness models. These models do not require manually creating and updating categorized word lists and, therefore, can be easily and objectively implemented in different languages, potentially allowing comparison of results across different languages. Furthermore, this method provides information about semantic clusters in phonematic VFTs, which cannot be obtained from traditional methods. Hence, this method could provide easily accessible digital biomarkers for executive and language functions in people with PD. %R 10.2196/46021 %U https://neuro.jmir.org/2023/1/e46021 %U https://doi.org/10.2196/46021 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41858 %T Using Hypothesis-Led Machine Learning and Hierarchical Cluster Analysis to Identify Disease Pathways Prior to Dementia: Longitudinal Cohort Study %A Huang,Shih-Tsung %A Hsiao,Fei-Yuan %A Tsai,Tsung-Hsien %A Chen,Pei-Jung %A Peng,Li-Ning %A Chen,Liang-Kung %+ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 11217, Taiwan, 886 2 28757711, lkchen2@vghtpe.gov.tw %K dementia %K machine learning %K cluster analysis %K disease %K condition %K symptoms %K data %K data set %K cardiovascular %K neuropsychiatric %K infection %K mobility %K mental conditions %K development %D 2023 %7 26.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia development is a complex process in which the occurrence and sequential relationships of different diseases or conditions may construct specific patterns leading to incident dementia. Objective: This study aimed to identify patterns of disease or symptom clusters and their sequences prior to incident dementia using a novel approach incorporating machine learning methods. Methods: Using Taiwan’s National Health Insurance Research Database, data from 15,700 older people with dementia and 15,700 nondementia controls matched on age, sex, and index year (n=10,466, 67% for the training data set and n=5234, 33% for the testing data set) were retrieved for analysis. Using machine learning methods to capture specific hierarchical disease triplet clusters prior to dementia, we designed a study algorithm with four steps: (1) data preprocessing, (2) disease or symptom pathway selection, (3) model construction and optimization, and (4) data visualization. Results: Among 15,700 identified older people with dementia, 10,466 and 5234 subjects were randomly assigned to the training and testing data sets, and 6215 hierarchical disease triplet clusters with positive correlations with dementia onset were identified. We subsequently generated 19,438 features to construct prediction models, and the model with the best performance was support vector machine (SVM) with the by-group LASSO (least absolute shrinkage and selection operator) regression method (total corresponding features=2513; accuracy=0.615; sensitivity=0.607; specificity=0.622; positive predictive value=0.612; negative predictive value=0.619; area under the curve=0.639). In total, this study captured 49 hierarchical disease triplet clusters related to dementia development, and the most characteristic patterns leading to incident dementia started with cardiovascular conditions (mainly hypertension), cerebrovascular disease, mobility disorders, or infections, followed by neuropsychiatric conditions. Conclusions: Dementia development in the real world is an intricate process involving various diseases or conditions, their co-occurrence, and sequential relationships. Using a machine learning approach, we identified 49 hierarchical disease triplet clusters with leading roles (cardio- or cerebrovascular disease) and supporting roles (mental conditions, locomotion difficulties, infections, and nonspecific neurological conditions) in dementia development. Further studies using data from other countries are needed to validate the prediction algorithms for dementia development, allowing the development of comprehensive strategies to prevent or care for dementia in the real world. %M 37494081 %R 10.2196/41858 %U https://www.jmir.org/2023/1/e41858 %U https://doi.org/10.2196/41858 %U http://www.ncbi.nlm.nih.gov/pubmed/37494081 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46935 %T Advance Care Planning Website for People With Dementia and Their Family Caregivers: Protocol for a Development and Usability Study %A Monnet,Fanny %A Dupont,Charlèss %A Smets,Tinne %A De Vleminck,Aline %A Van Audenhove,Chantal %A Van den Block,Lieve %A Pivodic,Lara %+ End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 499260389, fanny.monnet@vub.be %K advance care planning %K people with dementia %K technology %K development %K usability testing %K dementia %K caregiver %K web-based tools %K digital health %K user-centered approach %D 2023 %7 26.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Web-based tools for people with dementia and their family caregivers have considerably increased over the years and offer promising solutions to several unmet needs such as supporting self-care in daily life, facilitating treatment delivery, or ensuring their ability to communicate. The use of web-based tools in the field of advance care planning (ACP) for people with dementia and their family caregivers has yet to be explored and requires careful consideration, given the sensitive topic and the specific needs of people with dementia and their families. Objective: This paper reports the protocol for a study aiming to develop and simultaneously test the usability of an ACP website designed for, and with, people with dementia and their families. Methods: The development of the website is based on a process map for the development of web-based decision support interventions and on the Medical Research Council framework for complex intervention development and evaluation. Additionally, we apply a user-centered approach in combination with patient and public involvement (PPI) throughout the development process. We describe our iterative development approach to the website. Participants and a PPI group give feedback on 4 prototypes of the ACP website. For each iteration, we aim to include 12 participants (3 people with dementia, 3 family caregivers, and 3 dyads) in usability testing. In the first 3 iterations, usability testing includes (1) a think-aloud exercise, (2) researcher observations, and (3) the System Usability Scale questionnaire. The last iteration of usability testing is composed of a semistructured interview assessing the layout, content, face validity, and readability of the website. Qualitative data from the think-aloud exercises and interviews are analyzed using thematic analysis. Mean scores are calculated for the System Usability Scale questionnaire. Results: This study received approval from the Ethical Review Board of Brussels University Hospital of the Vrije Universiteit Brussel. Recruitment began in October 2021. The target date for paper submission of the results of the development and usability testing will be in 2023. Conclusions: The methods in this protocol describe a feasible and inclusive approach to the development of an ACP website together with people with dementia, their family caregivers, and other stakeholders. We provide a clear overview of how to combine PPI input and user-centered development methods, leading to a transparent and reliable development process. This protocol might stimulate the active participation of people with dementia, their caregivers, and regional stakeholders in future studies on web-based technologies. The results of this study will be used to refine the design and create a relevant and user-friendly ACP website that is ready to be tested in a larger evaluation study. International Registered Report Identifier (IRRID): DERR1-10.2196/46935 %M 37494084 %R 10.2196/46935 %U https://www.researchprotocols.org/2023/1/e46935 %U https://doi.org/10.2196/46935 %U http://www.ncbi.nlm.nih.gov/pubmed/37494084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48966 %T ChatGPT vs Google for Queries Related to Dementia and Other Cognitive Decline: Comparison of Results %A Hristidis,Vagelis %A Ruggiano,Nicole %A Brown,Ellen L %A Ganta,Sai Rithesh Reddy %A Stewart,Selena %+ Department of Computer Science and Engineering, University of California, Riverside, Winston Chung Hall, Room 317, Riverside, CA, 92521, United States, 1 9518272478, vagelis@cs.ucr.edu %K chatbots %K large language models %K ChatGPT %K web search %K language model %K Google %K aging %K cognitive %K cognition %K dementia %K gerontology %K geriatric %K geriatrics %K query %K queries %K information seeking %K search %D 2023 %7 25.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with dementia or other cognitive decline and their caregivers (PLWD) increasingly rely on the web to find information about their condition and available resources and services. The recent advancements in large language models (LLMs), such as ChatGPT, provide a new alternative to the more traditional web search engines, such as Google. Objective: This study compared the quality of the results of ChatGPT and Google for a collection of PLWD-related queries. Methods: A set of 30 informational and 30 service delivery (transactional) PLWD-related queries were selected and submitted to both Google and ChatGPT. Three domain experts assessed the results for their currency of information, reliability of the source, objectivity, relevance to the query, and similarity of their response. The readability of the results was also analyzed. Interrater reliability coefficients were calculated for all outcomes. Results: Google had superior currency and higher reliability. ChatGPT results were evaluated as more objective. ChatGPT had a significantly higher response relevance, while Google often drew upon sources that were referral services for dementia care or service providers themselves. The readability was low for both platforms, especially for ChatGPT (mean grade level 12.17, SD 1.94) compared to Google (mean grade level 9.86, SD 3.47). The similarity between the content of ChatGPT and Google responses was rated as high for 13 (21.7%) responses, medium for 16 (26.7%) responses, and low for 31 (51.6%) responses. Conclusions: Both Google and ChatGPT have strengths and weaknesses. ChatGPT rarely includes the source of a result. Google more often provides a date for and a known reliable source of the response compared to ChatGPT, whereas ChatGPT supplies more relevant responses to queries. The results of ChatGPT may be out of date and often do not specify a validity time stamp. Google sometimes returns results based on commercial entities. The readability scores for both indicate that responses are often not appropriate for persons with low health literacy skills. In the future, the addition of both the source and the date of health-related information and availability in other languages may increase the value of these platforms for both nonmedical and medical professionals. %M 37490317 %R 10.2196/48966 %U https://www.jmir.org/2023/1/e48966 %U https://doi.org/10.2196/48966 %U http://www.ncbi.nlm.nih.gov/pubmed/37490317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45658 %T Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: Systematic Review %A Lawson,Lauren %A Mc Ardle,Ríona %A Wilson,Sarah %A Beswick,Emily %A Karimi,Radin %A Slight,Sarah P %+ School of Pharmacy, Population Health Sciences Institute, Newcastle University, King George VI Building, Newcastle Upon Tyne, NE1 7RU, United Kingdom, 44 7739174547, sarah.slight@newcastle.ac.uk %K mild cognitive impairment %K MCI %K functional status %K activities of daily living %K instrumental activities of daily living %K IADLs %K digital technology %K mobile phone %D 2023 %7 25.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Subtle impairments in instrumental activities of daily living (IADLs) can be a key predictor of disease progression and are considered central to functional independence. Mild cognitive impairment (MCI) is a syndrome associated with significant changes in cognitive function and mild impairment in complex functional abilities. The early detection of functional decline through the identification of IADL impairments can aid early intervention strategies. Digital health technology is an objective method of capturing IADL-related behaviors. However, it is unclear how these IADL-related behaviors have been digitally assessed in the literature and what differences can be observed between MCI and normal aging. Objective: This review aimed to identify the digital methods and metrics used to assess IADL-related behaviors in people with MCI and report any statistically significant differences in digital endpoints between MCI and normal aging and how these digital endpoints change over time. Methods: A total of 16,099 articles were identified from 8 databases (CINAHL, Embase, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and Scopus), out of which 15 were included in this review. The included studies must have used continuous remote digital measures to assess IADL-related behaviors in adults characterized as having MCI by clinical diagnosis or assessment. This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Ambient technology was the most commonly used digital method to assess IADL-related behaviors in the included studies (14/15, 93%), with passive infrared motion sensors (5/15, 33%) and contact sensors (5/15, 33%) being the most prevalent types of methods. Digital technologies were used to assess IADL-related behaviors across 5 domains: activities outside of the home, everyday technology use, household and personal management, medication management, and orientation. Other recognized domains—culturally specific tasks and socialization and communication—were not assessed. Of the 79 metrics recorded among 11 types of technologies, 65 (82%) were used only once. There were inconsistent findings around differences in digital IADL endpoints across the cognitive spectrum, with limited longitudinal assessment of how they changed over time. Conclusions: Despite the broad range of metrics and methods used to digitally assess IADL-related behaviors in people with MCI, several IADLs relevant to functional decline were not studied. Measuring multiple IADL-related digital endpoints could offer more value than the measurement of discrete IADL outcomes alone to observe functional decline. Key recommendations include the development of suitable core metrics relevant to IADL-related behaviors that are based on clinically meaningful outcomes to aid the standardization and further validation of digital technologies against existing IADL measures. Increased longitudinal monitoring is necessary to capture changes in digital IADL endpoints over time in people with MCI. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022326861; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326861 %M 37490331 %R 10.2196/45658 %U https://www.jmir.org/2023/1/e45658 %U https://doi.org/10.2196/45658 %U http://www.ncbi.nlm.nih.gov/pubmed/37490331 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49679 %T The Senior Companion Program Plus for African American Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Randomized Controlled Trial %A Fields,Noelle L %A Xu,Ling %A Williams,Ishan C %A Gaugler,Joseph E %A Cipher,Daisha J %+ School of Social Work, University of Texas at Arlington, 501 W Mitchell, Arlington, TX, 76010, United States, 1 817 272 7390, noellefields@uta.edu %K Alzheimer disease %K dementia %K lay provider %K senior companion %K volunteer %K intervention %K culturally informed %K African American %K family caregivers %D 2023 %7 24.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRD) pose significant challenges as chronic health conditions in the United States. Additionally, there are notable disparities in the diagnosis and prevalence of ADRD among diverse populations. Specifically, African American populations have a higher risk of developing late-onset ADRD than White people, and missed diagnoses of ADRD are more common among older African American populations than older White populations. These disparities also impact African American ADRD family caregivers. Objective: The overall goal of this project is to develop a culturally informed, lay provider psychoeducational intervention named Senior Companion Program Plus (SCP Plus), which is specifically designed for African American ADRD caregivers and is potentially accessible, affordable, and sustainable. Methods: In the proposed explanatory sequential mixed methods study, a randomized controlled trial will be used that includes 114 African American family caregivers of a relative with ADRD who will participate in the 3-month SCP Plus program. Results: The study was funded on September 15, 2018, by the National Institutes of Health (1R15AG058182-01A1). Data collection began on May 16, 2019, but due to COVID-19 restrictions, ended 12 months into the planned 27-month recruitment period on March 31, 2023. The study was completed in June 30, 2023, and currently the results are being analyzed. Conclusions: The SCP Plus offers promise as an intervention that utilizes an existing platform for the delivery of a lay provider intervention and offers a novel approach for addressing gaps in accessible, community-based support for caregivers of people with ADRD. Trial Registration: ClinicalTrials.gov NCT03602391; https://classic.clinicaltrials.gov/ct2/show/NCT03602391 International Registered Report Identifier (IRRID): RR1-10.2196/49679 %M 37486759 %R 10.2196/49679 %U https://www.researchprotocols.org/2023/1/e49679 %U https://doi.org/10.2196/49679 %U http://www.ncbi.nlm.nih.gov/pubmed/37486759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47255 %T Financial Health of People Living With Dementia and Their Informal Care Partners: Protocol for a Mixed Methods Study %A Boone,Eli Robert %A Tai,Heiley %A Raich,Ali %A Vatsavai,Amulya %A Qin,Annie %A Thompson,Kayla %A Johri,Mohini %A Hu,Ruitian %A Golla,Vishnukamal %A Harris-Gersten,Melissa %+ Duke-Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, United States, 1 919 419 2504, Eli.Boone@Duke.edu %K avoiding care due to cost %K care rationing %K cost %K delayed care due to cost %K dementia %K economic strain %K financial burden %K financial distress %K financial hardship %K financial strain %K financial stress %K financial toxicity %K MCI %K mild cognitive impairment %K out-of-pocket costs %K out-of-pocket spending %D 2023 %7 11.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing body of academic literature focusing on the significant financial burdens placed on people living with cancer, but little evidence exists on the impact of rising costs of care in other vulnerable populations. This financial strain, also known as financial toxicity, can impact behavioral, psychosocial, and material domains of life for people diagnosed with chronic conditions and their care partners. New evidence suggests that populations experiencing health disparities, including those with dementia, face limited access to health care, employment discrimination, income inequality, higher burdens of disease, and exacerbating financial toxicity. Objective: The three study aims are to (1) adapt a survey to capture financial toxicity in people living with dementia and their care partners; (2) characterize the degree and magnitude of different components of financial toxicity in this population; and (3) empower the voice of this population through imagery and critical reflection on their perceptions and experiences relating to financial toxicity. Methods: This study uses a mixed methods approach to comprehensively characterize financial toxicity among people living with dementia and their care partners. To address aim 1, we will adapt elements from previously validated and reliable instruments, including the Comprehensive Score for Financial Toxicity and Patient-Reported Outcomes Measurement Information System, to develop a financial toxicity survey specific to dyads of people living with dementia and their care partners. A total of 100 dyads will complete the survey, and data will be analyzed using descriptive statistics and regression models to address aim 2. Aim 3 will be addressed using the process of “photovoice,” which is a qualitative, participatory research method that combines photography, verbal narratives, and critical reflection by groups of individuals to capture aspects of their environment and experiences with a certain topic. Quantitative results and qualitative findings will be integrated using a validated, joint display table mixed methods approach called the pillar integration process. Results: This study is ongoing, with quantitative findings and qualitative results anticipated by December 2023. Integrated findings will enhance the understanding of financial toxicity in individuals living with dementia and their care partners by providing a comprehensive baseline assessment. Conclusions: As one of the first studies on financial toxicity related to dementia care, findings from our mixed methods approach will support the development of new strategies for improving the costs of care. While this work focuses on those living with dementia, this protocol could be replicated for people living with other diseases and serve as a blueprint for future research efforts in this space. International Registered Report Identifier (IRRID): DERR1-10.2196/47255 %M 37432718 %R 10.2196/47255 %U https://www.researchprotocols.org/2023/1/e47255 %U https://doi.org/10.2196/47255 %U http://www.ncbi.nlm.nih.gov/pubmed/37432718 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46264 %T Association Between the Loss of Gait Harmony and Cognitive Impairment: Cross-Sectional Study %A Choi,Ju-Young %A Ha,Sang-Won %A Jeong,Da-Eun %A Lee,Jaeho %A Kim,Donghoon %A Min,Jin-Young %A Min,Kyoung-Bok %+ Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 1036954330, minkb@snu.ac.kr %K cognitive function %K gait phase %K physical performance %K dementia %K older adult %K aging %K asymmetric %K balance %K gait analysis %K cognition %K cognitive impairment %K gait %K gait pattern %K aging %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Functional limitations and disabilities have been associated with a decrease in cognitive function due to increasing age. Gait performance and cognitive function have been associated with gait variability in executive function, the phase domain in memory, and gait abnormalities in cognitive decline. Objective: Our study aimed to investigate whether gait harmony was associated with cognitive function in the older adult population. Moreover, we aimed to investigate whether gait harmony was associated with cognitive function and explore each cognitive function in a specific harmonic state. Methods: The study population included 510 adults aged ≥60 years who visited the Department of Neurology at the Veterans Health Service Medical Center, Seoul, South Korea. Gait data were collected using a 3D motion capture device with a wireless inertial measurement unit system. For cognitive function assessments, we used the Seoul Neuropsychological Screening Battery-Core test, which evaluates the level of cognitive function or impairment in 5 cognitive domains. Results: In general, the association between the Seoul Neuropsychological Screening Battery-Core tests and the stance-to-swing ratio in the >1.63 ratio group yielded lower β coefficients than those in the 1.50-1.63 ratio group. After adjustment for confounders, the odds ratio (OR) for the Digit Symbol Coding test (adjusted OR 0.42, 95% CI 0.20-0.88) and the Korean version of the Color Word Stroop Test: 60 seconds (adjusted OR 0.51, 95% CI 0.29-0.89) for frontal and executive function were significantly lower for the >1.63 ratio group than the reference group. Conclusions: Our findings suggest that the gait phase ratio is a valuable indicator of walking deficits and may also be associated with cognitive impairment in older adults. %M 37428538 %R 10.2196/46264 %U https://publichealth.jmir.org/2023/1/e46264 %U https://doi.org/10.2196/46264 %U http://www.ncbi.nlm.nih.gov/pubmed/37428538 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48927 %T Intergenerational Reminiscence Approach in Improving Emotional Well-Being of Older Asian Americans in Early-Stage Dementia Using Virtual Reality: Protocol for an Explanatory Sequential Mixed Methods Study %A Xu,Ling %A Hagedorn,Aaron %A Chi,Iris %+ School of Social Work, University of Texas at Arlington, 501 W Mitchell Street, Arlington, TX, 76019, United States, 1 817 272 3181, lingxu@uta.edu %K intergenerational reminiscence %K grandparent-grandchild %K dyad %K emotional %K well-being %K Asian American %K older adults %K dementia %K virtual reality %K VR %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: After a dementia diagnosis, Asian Americans experience anxiety, feelings of shame, and other negative effects. Emotional well-being is not only an important aspect of mental health, but also a quality of resilience that helps people bounce back faster from difficulties. However, few studies have addressed issues in developing, implementing, and testing intervention strategies to promote emotional well-being among older adults. Intergenerational solidarity between grandparents and grandchildren has been emphasized in Asian families and is beneficial for the health of persons with dementia. Reminiscence and life review have been identified as potentially effective intervention strategies for helping depression and emotional well-being for older adults. Objective: This proposed study aims to develop and implement an intergenerational reminiscence approach and evaluate its potential feasibility and effectiveness in improving the emotional well-being of older Asian American adults who have a recent dementia diagnosis. Methods: An explanatory sequential mixed methods design will be used in which quantitative data will first be collected and analyzed to identify subsamples of participants who report the greatest and least change in emotional well-being; then, these subsamples will be interviewed to further understand why or why not this intervention works for them. Older adults will receive 6 sessions of life review with grandchildren in virtual reality (VR; 1-1.5 hours each week for 6 weeks), aided by pictures and virtually traveling to important places in their life using Google Earth to look around at those places and remember important times. Quantitative survey data will be collected pre- and postintervention and at a 3-month follow-up. Qualitative interviews with selected participants will also be integrated into the study design. The quantitative data from the surveys will be entered into SPSS (IBM Corp) and analyzed using descriptive analyses, Pearson chi-square tests, nonparametric Friedman tests, or nonparametric Wilcox signed-rank tests (2-tailed). The qualitative data will be transcribed by research assistants, coded by the investigators independently, and analyzed with guidance from content analysis software (Atlas.ti; Atlas.ti Scientific Software Development GmbH). Results: The project was delayed due to the COVID-19 pandemic. Data collection started in late 2021, and 26 participants were recruited as of December 2022. While we are still cleaning and analyzing the quantitative data, the qualitative interviews showed promising results of this intergenerational reminiscence approach in improving emotional well-being among older Asian American adults who have cognitive impairment. Conclusions: Intergenerational reminiscence provided by grandchildren is promising in improving the emotional well-being of grandparents. VR technology is likely to be accepted by older adults. Future research may consider scaling up this pilot into a trackable, replicable model that includes more participants and develops a more rigorous study design with control groups to test the effectiveness of this intervention for older adults with dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/48927 %M 37358895 %R 10.2196/48927 %U https://www.researchprotocols.org/2023/1/e48927 %U https://doi.org/10.2196/48927 %U http://www.ncbi.nlm.nih.gov/pubmed/37358895 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e47152 %T The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis %A Yu,Ying %A Xiao,Lily %A Ullah,Shahid %A Meyer,Claudia %A Wang,Jing %A Pot,Anne Margriet %A Shifaza,Fathimath %+ College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 8 82013419, lily.xiao@flinders.edu.au %K informal caregivers %K dementia %K psychoeducation %K online %K web based %K qualitative research %K systematic review %K metasynthesis %D 2023 %7 29.5.2023 %9 Review %J JMIR Aging %G English %X Background: Informal caregivers of people living with dementia experience a higher level of physical and mental stress compared with other types of caregivers. Psychoeducation programs are viewed as beneficial for building caregivers’ knowledge and skills and for decreasing caregiver stress. Objective: This review aimed to synthesize the experiences and perceptions of informal caregivers of people with dementia when participating in web-based psychoeducation programs and the factors that enable and impede informal caregivers’ engagement in web-based psychoeducation programs. Methods: This review followed the Joanna Briggs Institute protocol of systematic review and meta-aggregation of qualitative studies. We searched 4 English databases, 4 Chinese databases, and 1 Arabic database in July 2021. Results: A total of 9 studies written in English were included in this review. From these studies, 87 findings were extracted and grouped into 20 categories. These categories were further synthesized into 5 findings: web-based learning as an empowering experience, peer support, satisfactory and unsatisfactory program content, satisfactory and unsatisfactory technical design, and challenges encountered in web-based learning. Conclusions: High-quality and carefully designed web-based psychoeducation programs offered positive experiences for informal caregivers of people living with dementia. To meet broader caregiver education and support needs, program developers should consider information quality and relevancy, the support offered, individual needs, flexibility in delivery, and connectedness between peers and program facilitators. %M 37247218 %R 10.2196/47152 %U https://aging.jmir.org/2023/1/e47152 %U https://doi.org/10.2196/47152 %U http://www.ncbi.nlm.nih.gov/pubmed/37247218 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45533 %T Focus Group Study of Medical Stakeholders to Inform the Development of Resilient Together for Dementia: Protocol for a Postdiagnosis Live Video Dyadic Resiliency Intervention %A Bannon,Sarah %A Brewer,Julie %A Cornelius,Talea %A Jackson,Jonathan %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Bradford %A Ritchie,Christine %A Vranceanu,Ana-Maria %+ Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, 100 Bowdoin Square, Suite 100, Boston, MA, MA, United States, 1 7733696338, smbannon@mgh.harvard.edu %K dementia %K stakeholders %K focus group %K intervention %K video %K telehealth %D 2023 %7 29.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRD) are increasingly common conditions that disrupt the lives of persons living with dementia and their spousal care partners. At the time of ADRD diagnoses, many couples experience challenges that produce emotional distress and relationship strain. At present, there are no interventions to address these challenges early after diagnoses to promote positive adjustment. Objective: The study protocol described here is part of the first phase of a larger program of research that aims to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention to be delivered over live video early after diagnosis, with the goal of preventing chronic emotional distress. This study will elicit and systematically summarize perspectives of ADRD medical stakeholders to inform the procedures (eg, recruitment and screening methods, eligibility, timing of intervention, and intervention delivery) of the first iteration of RT-ADRD prior to pilot-testing. Methods: We will recruit interdisciplinary medical stakeholders (eg, neurologists, social workers, neuropsychologists, care coordinators, and speech language pathologists) from academic medical center clinics in the departments treating persons living with dementia such as neurology, psychiatry, and geriatric medicine via flyers and word-of-mouth referrals from clinic directors and members of relevant organizations (eg, dementia care collaboratives and Alzheimer disease research centers). The participants will complete electronic screening and consent procedures. Consenting individuals will then participate in a 30- to 60-minute qualitative virtual focus group, held either via telephone or Zoom, using an interview guide designed to assess provider experiences with postdiagnosis clinical care and to gather feedback on the proposed RT-ADRD protocol. The participants will also have the opportunity to participate in an optional exit interview and web-based survey to gather additional feedback. Qualitative data will be analyzed using a hybrid inductive-deductive approach and the framework method for thematic synthesis. We will conduct approximately 6 focus groups with 4-6 individuals in each group (maximum N=30 individuals; until saturation is reached). Results: Data collection began in November 2022 and will continue through June 2023. We anticipate that the study will be completed by late 2023. Conclusions: The results from this study will inform the procedures of the first live video RT-ADRD dyadic resiliency intervention focused on the prevention of chronic emotional and relational distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from stakeholders on ways to best deliver our early prevention–focused intervention and gain detailed feedback on study procedures prior to further testing. International Registered Report Identifier (IRRID): DERR1-10.2196/45533 %M 37247224 %R 10.2196/45533 %U https://www.researchprotocols.org/2023/1/e45533 %U https://doi.org/10.2196/45533 %U http://www.ncbi.nlm.nih.gov/pubmed/37247224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45274 %T Care Partner Inclusion of People Hospitalized With Alzheimer Disease and Related Dementias: Protocol for a Mixed Methods Systems Engineering Approach to Designing a Health Care System Toolkit %A Fields,Beth %A Still,Catherine %A Medlin,Austin %A Strayer,Andrea %A Arbaje,Alicia I %A Gilmore-Bykovskyi,Andrea %A Werner,Nicole %+ Department of Kinesiology, University of Wisconsin-Madison, 2170 Medical Science Center, 1300 University Ave, Madison, WI, 53706, United States, 1 608 263 7295, befields2@wisc.edu %K caregiving %K co-design %K dementia %K health care %K systems %K mixed methods %D 2023 %7 16.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners’ active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. Objective: This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. Methods: The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. Results: The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. Conclusions: We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. International Registered Report Identifier (IRRID): DERR1-10.2196/45274 %M 37191978 %R 10.2196/45274 %U https://www.researchprotocols.org/2023/1/e45274 %U https://doi.org/10.2196/45274 %U http://www.ncbi.nlm.nih.gov/pubmed/37191978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36590 %T Revealing the Roles of Part-of-Speech Taggers in Alzheimer Disease Detection: Scientific Discovery Using One-Intervention Causal Explanation %A Wen,Bingyang %A Wang,Ning %A Subbalakshmi,Koduvayur %A Chandramouli,Rajarathnam %+ Department of Electrical and Computer Engineering, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07002, United States, 1 2012165000, bwen4@stevens.edu %K explainable machine learning %K Alzheimer disease %K natural language processing %K causal inference %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Recently, rich computational methods that use deep learning or machine learning have been developed using linguistic biomarkers for the diagnosis of early-stage Alzheimer disease (AD). Moreover, some qualitative and quantitative studies have indicated that certain part-of-speech (PoS) features or tags could be good indicators of AD. However, there has not been a systematic attempt to discover the underlying relationships between PoS features and AD. Moreover, there has not been any attempt to quantify the relative importance of PoS features in detecting AD. Objective: Our goal was to disclose the underlying relationship between PoS features and AD, understand whether PoS features are useful in AD diagnosis, and explore which PoS features play a vital role in the diagnosis. Methods: The DementiaBank, containing 1049 transcripts from 208 patients with AD and 243 transcripts from 104 older control individuals, was used. A total of 27 PoS features were extracted from each record. Then, the relationship between AD and each of the PoS features was explored. A transformer-based deep learning model for AD prediction using PoS features was trained. Then, a global explainable artificial intelligence method was proposed and used to discover which PoS features were the most important in AD diagnosis using the transformer-based predictor. A global (model-level) feature importance measure was derived as a summary from the local (example-level) feature importance metric, which was obtained using the proposed causally aware counterfactual explanation method. The unique feature of this method is that it considers causal relations among PoS features and can, hence, preclude counterfactuals that are improbable and result in more reliable explanations. Results: The deep learning–based AD predictor achieved an accuracy of 92.2% and an F1-score of 0.955 when distinguishing patients with AD from healthy controls. The proposed explanation method identified 12 PoS features as being important for distinguishing patients with AD from healthy controls. Of these 12 features, 3 (25%) have been identified by other researchers in previous works in psychology and natural language processing. The remaining 75% (9/12) of PoS features have not been previously identified. We believe that this is an interesting finding that can be used in creating tests that might aid in the diagnosis of AD. Note that although our method is focused on PoS features, it should be possible to extend it to more types of features, perhaps even those derived from other biomarkers, such as syntactic features. Conclusions: The high classification accuracy of the proposed deep learner indicates that PoS features are strong clues in AD diagnosis. There are 12 PoS features that are strongly tied to AD, and because language is a noninvasive and potentially cheap method for detecting AD, this work shows some promising directions in this field. %M 37129944 %R 10.2196/36590 %U https://formative.jmir.org/2023/1/e36590 %U https://doi.org/10.2196/36590 %U http://www.ncbi.nlm.nih.gov/pubmed/37129944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37269 %T An Emerging Screening Method for Interrogating Human Brain Function: Tutorial %A Sudre,Gustavo %A Bagić,Anto I %A Becker,James T %A Ford,John P %+ Brain FIT Imaging, LLC, 141 Main Street, Unadilla, NY, 13849, United States, 1 607 435 0930, gsudre@brainfitimaging.com %K screening %K brain function %K cognition %K magnetoencephalography %K MEG %K neuroimaging %K tutorial %K tool %K cognitive test %K neuroimaging %K signal %K cognitive function %D 2023 %7 27.4.2023 %9 Tutorial %J JMIR Form Res %G English %X Cognitive decline can be observed due to a myriad of causes. Clinicians would benefit from a noninvasive quantitative tool to screen and monitor brain function based on direct measures of neural features. In this study, we used neuroimaging data from magnetoencephalography (with a whole-head Elekta Neuromag 306 sensor system) to derive a set of features that strongly correlate with brain function. We propose that simple signal characteristics related to peak variability, timing, and abundance can be used by clinicians as a screening tool to investigate cognitive function in at-risk individuals. Using a minimalistic set of features, we were able to perfectly distinguish between participants with normative and nonnormative brain function, and we were also able to successfully predict participants’ Mini-Mental Test score (r=0.99; P<.001; mean absolute error=0.413). This set of features can be easily visualized in an analog fashion, providing clinicians with several graded measurements (in comparison to a single binary diagnostic tool) that can be used for screening and monitoring cognitive decline. %M 37103988 %R 10.2196/37269 %U https://formative.jmir.org/2023/1/e37269 %U https://doi.org/10.2196/37269 %U http://www.ncbi.nlm.nih.gov/pubmed/37103988 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41712 %T Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday Program for Older Adults: Single-Arm Pre-Post Trial %A Pike,Kerryn %A Moller,Carl I %A Bryant,Christina %A Farrow,Maree %A Dao,Duy P %A Ellis,Kathryn A %+ School of Applied Psychology, Griffith Centre for Mental Health & Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, 4222, Australia, 61 756788606, k.pike@griffith.edu.au %K cognition %K learning %K internet-based intervention %K social support %K subjective cognitive decline %K mobile phone %D 2023 %7 20.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. Objective: We report on OPTIMiSE’s feasibility, acceptability, and efficacy. Methods: Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. Results: OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=−0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. Conclusions: This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv International Registered Report Identifier (IRRID): RR2-10.3233/ADR-200251 %M 37079356 %R 10.2196/41712 %U https://www.jmir.org/2023/1/e41712 %U https://doi.org/10.2196/41712 %U http://www.ncbi.nlm.nih.gov/pubmed/37079356 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40762 %T Usability of a Community-Based Dementia Resource Website: Mixed Methods Study %A Thomas,Missy %A Henderson,Dean %A Trudel,Chantal %A Thomas,Neil %+ Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada, 1 1 613 562 6262 ext 4071, nthomas@bruyere.org %K dementia %K caregivers %K eHealth %K community resources %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Many individuals living with dementia want to live in their own homes for as long as possible. To do so, they frequently require assistance with activities of daily living, which is often provided by friends and relatives acting as informal care partners. In Canada, many informal care partners are currently overworked and overwhelmed. Although community-based dementia-inclusive resources are available to support them, care partners often struggle to find them. Dementia613.ca was created to make the process of finding community dementia-inclusive resources simpler and more straightforward by bringing them together in one eHealth website. Objective: The objective of our study was to determine if dementia613.ca is meeting the goal of connecting care partners and persons living with dementia to dementia-inclusive resources in their community. Methods: A review and assessment of the website was conducted using 3 evaluation methods: web analytics, questionnaires, and task analysis. Google Analytics was used to collect data related to website use over a 9-month period. Data on site content and user characteristics were collected. Furthermore, 2 web-based self-administered questionnaires were developed: one intended for care partners and persons living with dementia, and the other intended for businesses and organizations interested in serving persons living with dementia. Both gathered data on user characteristics and included standard questions used in website evaluations. Responses were collected over a 6-month period. Scenarios, tasks, and questions were developed for the moderated, remote, and task-analysis sessions. These tasks and questions determined how effectively persons living with dementia and their care partners can use dementia613.ca. Overall, 5 sessions were held with persons experiencing moderate cognitive decline and with care partners of persons living with dementia. Results: This evaluation showed that the idea behind dementia613.ca is strong and appeals to persons living with dementia, their care partners, and the businesses and organizations serving this market. Participants indicated that it is a useful community resource that meets a previously unfulfilled need in the area, and highlighted the benefits of bringing community resources together on 1 website. In our questionnaire, >60% (19/29, 66%) of people living with dementia and their care partners and 70% (7/10) of businesses and organizations agreed that the website made it easier to find relevant dementia-inclusive resources. There is room for improvement; participants indicated that the navigation and search features could be further developed. Conclusions: We believe that the dementia613.ca model could be used to inspire and guide the creation of dementia resource websites in other regions in Ontario and beyond. The framework behind it is generalizable and could be replicated to help care partners and persons living with dementia find local resources more easily. %M 37079355 %R 10.2196/40762 %U https://aging.jmir.org/2023/1/e40762 %U https://doi.org/10.2196/40762 %U http://www.ncbi.nlm.nih.gov/pubmed/37079355 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43408 %T The Development of a UK Culturally Adapted and Modified Version of the Person Attuned Musical Interactions Manual: Protocol for a 2-Phase Mixed Methods Study %A Waters,Bryony %A Orrell,Martin %A McDermott,Orii %+ Institute of Mental Health, School of Medicine, University of Nottingham, Jubillee Campus, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 823 1294, bryony.waters@nottingham.ac.uk %K psychosocial intervention %K music %K dementia %K interactions %K care homes %K care staff training tool %K tool %K research %K impairment %K training %K communication %K intervention %K quality of life %K care %K development %K language %D 2023 %7 18.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous research has suggested that care home interactions need significant improvements, especially those between staff and residents with dementia. Reasons for the lack of interactions are staff time pressures and residents’ language impairments. Although residents may experience reduced language abilities, they can continue to communicate through other forms, including nonverbal communication and music. Person Attuned Musical Interactions (PAMI) is a staff training tool that provides staff with music therapy skill-sharing to promote high-quality interactions between staff and residents using nonverbal communication and music. The tool was originally developed in Denmark. To ensure that the tool is appropriate for UK care homes, a team of researchers in the United Kingdom have modified and culturally adapted the tool. Objective: This study aims to investigate the appropriateness of the adapted and modified manual for UK care homes and to explore the impact of PAMI on residents with dementia and care staff. Methods: The project consists of 2 phases, a qualitative field-testing study and a mixed methods evaluation study, which have been developed following the Medical Research Council’s guidelines for complex interventions. Care staff and residents with dementia will be recruited from care homes in Lincolnshire, where the care staff will be trained in the PAMI intervention before implementing the intervention in their daily routines. Fortnightly reflective sessions will be provided throughout the phases to provide supervision and monitoring. The qualitative methods include interviews, reflective session transcripts, diary entries, and resident experience questionnaires. The quantitative outcome measures are residents’ music engagement, staff’s dementia competence, residents’ quality of life, and staff burden. The resident’s music engagement will be administered at 9 fortnightly time points. Staff’s dementia competence, resident’s quality of life, and staff burden will be administered at preintervention and postintervention time points. Results: The study has been funded by The Music Therapy Charity as part of a PhD studentship. The study began recruiting in September 2021. The research team aims to publish the results of the first phase in July to September 2023 and those of the second phase in October to December 2023. Conclusions: This study will be the first to investigate the modified version of PAMI. Therefore, it will provide feedback on the appropriateness of the manual for UK care homes. The PAMI intervention has the potential to offer high-quality music intervention training to a larger population of care homes who may currently be restricted by finances, the availability of time, and a lack of training opportunities. International Registered Report Identifier (IRRID): DERR1-10.2196/43408 %M 37071461 %R 10.2196/43408 %U https://www.researchprotocols.org/2023/1/e43408 %U https://doi.org/10.2196/43408 %U http://www.ncbi.nlm.nih.gov/pubmed/37071461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43607 %T Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Abuelezz,Israa %A AlSaad,Rawan %A Al-Jafar,Eiman %A Ahmed,Arfan %A Aziz,Sarah %A Nashwan,Abdulqadir %A Sheikh,Javaid %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, 202 A15, Ezdan Oasis, Doha, Qatar, 974 55708549, alaa_alzoubi88@yahooo.com %K serious games %K cognitive training %K learning %K exergames %K mild cognitive impairment %K Alzheimer disease %K dementia %K learning %K systematic reviews %K meta-analysis %K mobile phone %D 2023 %7 12.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Learning disabilities are among the major cognitive impairments caused by aging. Among the interventions used to improve learning among older adults are serious games, which are participative electronic games designed for purposes other than entertainment. Although some systematic reviews have examined the effectiveness of serious games on learning, they are undermined by some limitations, such as focusing on older adults without cognitive impairments, focusing on particular types of serious games, and not considering the comparator type in the analysis. Objective: This review aimed to evaluate the effectiveness of serious games on verbal and nonverbal learning among older adults with cognitive impairment. Methods: Eight electronic databases were searched to retrieve studies relevant to this systematic review and meta-analysis. Furthermore, we went through the studies that cited the included studies and screened the reference lists of the included studies and relevant reviews. Two reviewers independently checked the eligibility of the identified studies, extracted data from the included studies, and appraised their risk of bias and the quality of the evidence. The results of the included studies were summarized using a narrative synthesis or meta-analysis, as appropriate. Results: Of the 559 citations retrieved, 11 (2%) randomized controlled trials (RCTs) ultimately met all eligibility criteria for this review. A meta-analysis of 45% (5/11) of the RCTs revealed that serious games are effective in improving verbal learning among older adults with cognitive impairment in comparison with no or sham interventions (P=.04), and serious games do not have a different effect on verbal learning between patients with mild cognitive impairment and those with Alzheimer disease (P=.89). A meta-analysis of 18% (2/11) of the RCTs revealed that serious games are as effective as conventional exercises in promoting verbal learning (P=.98). We also found that serious games outperformed no or sham interventions (4/11, 36%; P=.03) and conventional cognitive training (2/11, 18%; P<.001) in enhancing nonverbal learning. Conclusions: Serious games have the potential to enhance verbal and nonverbal learning among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of evidence, the small sample size in most of the meta-analyzed studies (6/8, 75%), and the paucity of studies included in the meta-analyses. Thus, until further convincing proof of their effectiveness is offered, serious games should be used to supplement current interventions for verbal and nonverbal learning rather than replace them entirely. Further studies are needed to compare serious games with conventional cognitive training and conventional exercises, as well as different types of serious games, different platforms, different intervention periods, and different follow-up periods. Trial Registration: PROSPERO CRD42022348849; https://tinyurl.com/y6yewwfa %M 37043277 %R 10.2196/43607 %U https://www.jmir.org/2023/1/e43607 %U https://doi.org/10.2196/43607 %U http://www.ncbi.nlm.nih.gov/pubmed/37043277 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46093 %T Understanding Intersectional Ageism and Stigma of Dementia: Protocol for a Scoping Review %A Bacsu,Juanita-Dawne %A Kortzman,August %A Fraser,Sarah %A Chasteen,Alison L %A MacDonald,Jennifer %A O'Connell,Megan E %+ School of Nursing, Thompson Rivers University, 805 TRU Way, Kamloops, BC, V2C 0C8, Canada, 1 3062504399, jbacsu@tru.ca %K stigma %K dementia %K ageism %K definitions %K measures %K older adults %K quality of life %K social inclusion %K health care access %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ageism and stigma reduce the quality of life of older adults living with dementia. However, there is a paucity of literature addressing the intersection and combined effects of ageism and stigma of dementia. This intersectionality, rooted in the social determinants of health (ie, social support and access to health care), compounds health disparities and is, therefore, an important area of inquiry. Objective: This scoping review protocol outlines a methodology that will be used to examine ageism and stigma confronting older adults living with dementia. The aim of this scoping review will be to identify the definitional components, indicators, and measures used to track and evaluate the impact of ageism and stigma of dementia. More specifically, this review will focus on examining the commonalities and differences in definitions and measures to develop a better understanding of intersectional ageism and stigma of dementia as well as the current state of the literature. Methods: Guided by Arksey and O’Malley’s 5-stage framework, our scoping review will be conducted by searching 6 electronic databases (PsycINFO, MEDLINE, Web of Science, CINAHL, Scopus, and Embase) and a web-based search engine (ie, Google Scholar). Reference lists of relevant journal articles will be hand-searched to identify additional articles. The results from our scoping review will be presented using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) checklist. Results: This scoping review protocol was registered with the Open Science Framework on January 17, 2023. Data collection and analysis and manuscript writing will occur from March to September 2023. The target date for manuscript submission will be October 2023. Findings from our scoping review will be disseminated through various means, such as journal articles, webinars, national networks, and conference presentations. Conclusions: Our scoping review will summarize and compare the core definitions and measures used to understand ageism and stigma toward older adults with dementia. This is significant because there is limited research addressing the intersectionality of ageism and stigma of dementia. Accordingly, findings from our study may provide critical knowledge and insight to help inform future research, programs, and policies to address intersectional ageism and stigma of dementia. Trial Registration: Open Science Framework; https://osf.io/yt49k International Registered Report Identifier (IRRID): PRR1-10.2196/46093 %M 37040178 %R 10.2196/46093 %U https://www.researchprotocols.org/2023/1/e46093 %U https://doi.org/10.2196/46093 %U http://www.ncbi.nlm.nih.gov/pubmed/37040178 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42972 %T A WeChat-based Intervention, Wellness Enhancement for Caregivers (WECARE), for Chinese American Dementia Caregivers: Pilot Assessment of Feasibility, Acceptability, and Preliminary Efficacy %A Hong,Y Alicia %A Shen,Kang %A Han,Hae-Ra %A Ta Park,Van %A Bagchi,Pramita %A Lu,Huixing Kate %A Chen,Hsiaoyin %A Wang,Judy Huei-yu %+ Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Dr. MS 1j3, Fairfax, VA, 22030, United States, 1 7039931929, yhong22@gmu.edu %K Alzheimer disease %K dementia %K caregiver %K Chinese American %K mHealth intervention %K social media %K WeChat %K mHealth %K mobile health %K informal care %K caregiving %K family care %K spousal care %K minority %K ethnic %K cultural %K Chinese %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Chinese American family caregivers of persons with dementia experience high rates of psychosocial distress and adverse health outcomes. Due to their immigrant and minority status, they face substantial obstacles to care and support, including stigma and misperception of dementia, limited knowledge and use of welfare and services, and poor social support. Few interventions have been developed or tested for this vulnerable population. Objective: This study aims to pilot-test the Wellness Enhancement for Caregivers (WECARE) intervention, a culturally tailored program delivered via WeChat, a social media app highly popular in the Chinese population. The 7-week WECARE was designed specifically for Chinese American dementia caregivers to improve their caregiving skills, reduce stress, and enhance psychosocial well-being. Feasibility, acceptability, and preliminary efficacy of the WECARE were assessed in this pilot. Methods: A total of 24 Chinese American family caregivers of persons with dementia were recruited for a pre-post 1-arm trial of the WECARE. By subscribing to the WECARE official account, participants received interactive multimedia programs on their WeChat account multiple times a week for 7 weeks. A backend database automatically delivered program components and tracked user activities. Three online group meetings were organized to facilitate social networking. Participants completed a baseline and a follow-up survey. Feasibility was assessed by the follow-up rate and curriculum completion rate; acceptability was assessed by user satisfaction and perceived usefulness of the program; and efficacy was assessed with pre-post differences in 2 primary outcomes of depressive symptoms and caregiving burden. Results: The intervention was completed by 23 participants with a retention rate of 96%. Most of them (n=20, 83%) were older than 50 years and the majority (n=17, 71%) were female. The backend database revealed that the mean curriculum completion rate was 67%. Participants also reported high rates of user satisfaction and perceived usefulness of the intervention and high ratings of weekly programs. The intervention led to significant improvement in participants’ psychosocial health outcomes; their depressive symptoms reduced from 5.74 to 3.35 with an effect size of −0.89 and caregiving burden decreased from 25.78 to 21.96 with an effect size of −0.48. Conclusions: This pilot study suggests that WeChat-based WECARE intervention was feasible and acceptable; it also demonstrated initial efficacy in improving psychosocial well-being in Chinese American dementia caregivers. Further research with a control group is needed to assess its efficacy and effectiveness. The study highlights the need for more culturally appropriate mobile health interventions for Chinese American family caregivers of persons with dementia. %M 37018042 %R 10.2196/42972 %U https://aging.jmir.org/2023/1/e42972 %U https://doi.org/10.2196/42972 %U http://www.ncbi.nlm.nih.gov/pubmed/37018042 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42655 %T Behind the Scenes of a Technologically Enhanced Intervention for Caregivers of People With Dementia: Protocol for a Feasibility and Acceptability Study %A Gómez-Morales,Abigail %A Coon,David %A Joseph,Rodney P %A Pipe,Teri %+ Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd Street, MC 3020, Phoenix, AZ, 85004, United States, 1 480 307 5308, david.w.coon@asu.edu %K Alzheimer's disease %K dementia %K virtual reality %K information and communication technology %K ICT %K caregivers %K pilot study %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer's disease affects 55 million people worldwide. As the disease progresses, these individuals require a devoted caregiver, often a family member, who provides evolving complex care. Caregivers can experience a variety of ongoing stressors, resulting in reductions in caregiver emotional well-being (and other quality-of-life indicators). Information and communication technologies provide an excellent opportunity to train caregivers remotely and help them to manage these stressors and related distress. Objective: This protocol describes the theoretical rationale, study design, and methods of a new, technologically enhanced psychoeducational skill-building intervention for caregivers of people with dementia that includes a virtual reality component. Methods: Through Alzheimer’s Eyes is a 4-week, single-arm, pre-post test pilot study consisting of 4 sessions of 90 minutes each that are delivered by videoconferencing. These sessions include a weekly virtual reality experience characterizing the journey of an older Latina with Alzheimer's disease from her perspective to help caregivers see through the eyes of a person with dementia. The 4 sessions cover the skill-training topics of communication, managing challenging behaviors and unhelpful thoughts, the importance of self-care, and mindfulness—all of which are key components designed to reduce stress and distress in family caregivers. Individual interviews conducted before and after the intervention gather participant insights into the intervention, evaluate its feasibility and acceptability, and assess its impact on key outcomes. Results: Data collection for the study started in January 2022, and the results are expected to be submitted for publication in the second half of 2023. Twenty caregivers from the United States have completed the workshop to date. Preliminary data gathered from these participants support the intervention’s feasibility and acceptability. Conclusions: Through Alzheimer’s Eyes leverages existing technology combined with psychoeducational skill building to help caregivers manage their stress, regardless of their location. International Registered Report Identifier (IRRID): DERR1-10.2196/42655 %M 37000480 %R 10.2196/42655 %U https://www.researchprotocols.org/2023/1/e42655 %U https://doi.org/10.2196/42655 %U http://www.ncbi.nlm.nih.gov/pubmed/37000480 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44007 %T Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process %A Brown,Ellen L %A Ruggiano,Nicole %A Allala,Sai Chaithra %A Clarke,Peter J %A Davis,Debra %A Roberts,Lisa %A Framil,C Victoria %A Muñoz,Maríateresa Teri Hernandez %A Hough,Monica Strauss %A Bourgeois,Michelle S %+ Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th St, Office 226, Miami, FL, 33199, United States, 1 3053481312, ebrown@fiu.edu %K health technology %K interdisiplinary team %K older adults %K dementia %K communication %K communication aids for disabled persons %K communication boards %K app %K Alzheimer disease %K family %K caregiver %K clinical care %K development %K speech %K psychosocial intervention %K software design %D 2023 %7 15.3.2023 %9 Viewpoint %J JMIR Aging %G English %X According to the 2022 Alzheimer’s Association Facts and Figures, more than 6 million Americans have Alzheimer disease and related dementias. They are cared for by millions of family members, friends, or other unpaid caregivers. Communication deficits are common among persons with Alzheimer disease and related dementias and pose challenges to caregiving and clinical care, which is already complex. An interdisciplinary team developed a mobile app prototype to improve communications between people living with dementia and their caregivers and providers and to promote person-centered care. This viewpoint paper provides a road map for how the interdisciplinary team worked together to develop and plan for the implementation and evaluation of a new evidence-based app. In our paper, we provide an 8-step process used by a team of clinicians, researchers, and software engineers to develop a new app to meet the needs of people living with dementia and their caregiver(s). The planned clinical trial has been registered at ClinicalTrials.gov (NCT04571502; https://clinicaltrials.gov/ct2/show/NCT04571502).International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 %M 36920462 %R 10.2196/44007 %U https://aging.jmir.org/2023/1/e44007 %U https://doi.org/10.2196/44007 %U http://www.ncbi.nlm.nih.gov/pubmed/36920462 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44274 %T The Bidirectional Association Between Cognitive Function and Gait Speed in Chinese Older Adults: Longitudinal Observational Study %A Li,Haibin %A Zhang,Jiajia %A Zou,Xinye %A Jia,Xiuqin %A Zheng,Deqiang %A Guo,Xiuhua %A Xie,Wuxiang %A Yang,Qi %+ Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Number 8, Gongti South Road, Chaoyang District, Beijing, 100020, China, 86 01085231928, yangyangqiqi@gmail.com %K aging %K cognitive function %K gait speed %K cross-lagged panel models %K longitudinal study %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cognitive and gait speed decline are common conditions in older adults and are often associated with future adverse consequences. Although an association between cognitive function and gait speed has been demonstrated, its temporal sequence remains unclear, especially in older Chinese adults. Clarifying this could help identify interventions to improve public health in older adults. Objective: This study aims to examine the longitudinal reciprocal association between gait speed and cognitive function and the possible temporal sequence of changes in both factors in a national longitudinal cohort. Methods: Data were derived from 2 waves (2011 baseline and 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants 60 years or older, without dementia or Parkinson disease at baseline, and with completed data on gait speed and cognition at both baseline and follow-up were included. Usual gait speed was measured over two 2.5-m walks. Mental intactness and episodic memory were used to assess global cognitive function. Cross-lagged panel models and linear mixed-effects models were used to examine the association between cognition and gait speed over time. Standardized coefficients were reported. Results: A total of 3009 participants (mean age 66.4 years, SD 5.4 years; 1422/3009, 47.26%, female participants) were eligible for inclusion in our analyses. Cross-lagged panel analyses revealed that after accounting for baseline gait speed, cognition, and potential confounders, baseline global cognition (β=.117, 95% CI 0.082-0.152; P<.001), mental intactness (β=.082, 95% CI 0.047-0.118; P<.001), and episodic memory (β=.102, 95% CI 0.067-0.137; P<.001) were associated with subsequent gait speed. Simultaneously, baseline gait speed was also associated with subsequent global cognition (β=.056, 95% CI 0.024-0.087; P=.001), mental intactness (β=.039, 95% CI 0.008-0.069; P=.01), and episodic memory (β=.057, 95% CI 0.023-0.092; P=.001). The comparison of standardized cross-lagged coefficients suggested that the effect size of baseline global cognition on subsequent gait speed was significantly larger than the reverse effect (χ12=6.50, P for difference=.01). However, the effects of both mental intactness and episodic memory on subsequent gait speed were not significantly stronger than those of the reverse pathway (χ12=3.33, P for difference=.07 and χ12=3.21, P for difference=.07). Linear mixed-effects analyses further supported these bidirectional relationships, revealing that lower baseline cognitive scores predicted steeper declines in gait speed trajectory, and slower baseline gait speed predicted more declines in cognitive trajectory over time. Conclusions: There is a longitudinal bidirectional association between usual gait speed and both global cognitive function and specific domains of mental intactness and episodic memory among Chinese older adults. Baseline global cognition is likely to have a stronger association with subsequent gait speed than the reverse pathway. This interlinkage is noteworthy and may have implications for public health. Maintaining normal cognitive function may be an important interventional strategy for mitigating age-related gait speed reduction. %M 36917163 %R 10.2196/44274 %U https://publichealth.jmir.org/2023/1/e44274 %U https://doi.org/10.2196/44274 %U http://www.ncbi.nlm.nih.gov/pubmed/36917163 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44918 %T Health Experiences of Sexual and Gender Minority People Living With Dementia and Their Care Partners: Protocol for a Scoping Review %A May,Jennifer T %A Harris,Melissa Louise %+ School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27701, United States, 1 919 684 4248, jennifer.may@duke.edu %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K dementia %K caregiver %K identity %K gender minority %K health inequity %K vulnerable population %K health care %K health disparity %K scoping review protocol %K sexual minority %D 2023 %7 13.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: People living with dementia and their care partners who identify as a sexual and gender minority (SGM) often experience specific health inequities and disparities due to discrimination related to age, cognitive impairment, and being SGM. Objective: The purpose of this scoping review is to identify, explore, and synthesize the state of the science regarding the health and health care experiences of SGM people living with dementia and their care partners. This review also aims to identify gaps in research and set forth key recommendations to improve the health and health care experiences of SGM people living with dementia and their care partners by advancing health equity through research, policy, and practice. Methods: The protocol follows the guidelines set forth by Joanna Briggs Institute protocol for scoping reviews. Steps of this framework that will be followed include (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. This scoping review will explore several electronic databases, including MEDLINE, Embase, CINAHL, AgeLine, PsychINFO, and Scopus. Health librarians will conduct the initial search for articles that are in English, include people living with dementia who identify as SGM, SGM people living with dementia and their care partners, or SGM care partners caring for people with dementia. Studies must be peer reviewed and focus on the phenomenon of interest, which is the health and health care experiences of participants. Covidence will be used to review abstracts and full-text articles and to screen articles. After the search has been completed, 2 independent reviewers will screen article titles and abstracts to identify eligibility. Discrepancies will be discussed and decided upon by the 2 reviewers. Relevant studies will be collected, and data will be extracted and charted to summarize key findings. Key findings will be presented to a community stakeholder group of SGM care partners and people living with dementia, and a listening session will be convened. Results: This scoping review will identify the state of the science of health and health care experiences of people living with dementia and their care partners who identify as SGM. We will identify gaps and provide recommendations to inform future research, policy, and practice to improve health and health care experiences of SGM people living with dementia and their care partners. Conclusions: Little is known about people living with dementia and their care partners who identify as SGM. This scoping review will be one of the first to identify the health and health care experiences of people living with dementia and their care partners who identify as SGM. The results of this review will be used to guide future interventions and to inform future policy and practice to improve health care and reduce health disparities in this population. International Registered Report Identifier (IRRID): PRR1-10.2196/44918 %M 36757411 %R 10.2196/44918 %U https://www.researchprotocols.org/2023/1/e44918 %U https://doi.org/10.2196/44918 %U http://www.ncbi.nlm.nih.gov/pubmed/36757411 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41936 %T The Impact of Health Information Exchange on In-Hospital and Postdischarge Mortality in Older Adults with Alzheimer Disease Readmitted to a Different Hospital Within 30 Days of Discharge: Cohort Study of Medicare Beneficiaries %A Turbow,Sara %A Vaughan,Camille P %A Culler,Steven D %A Hepburn,Kenneth W %A Rask,Kimberly J %A Perkins,Molly M %A Clevenger,Carolyn K %A Ali,Mohammed K %+ Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 404 251 8897, sara.turbow@emory.edu %K readmissions %K care fragmentation %K health information exchange %K mortality %K Alzheimer disease %K electronic health information %K information sharing %K older adults %K information exchange %K hospital system %K health informatics %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Although electronic health information sharing is expanding nationally, it is unclear whether electronic health information sharing improves patient outcomes, particularly for patients who are at the highest risk of communication challenges, such as older adults with Alzheimer disease. Objective: To determine the association between hospital-level health information exchange (HIE) participation and in-hospital or postdischarge mortality among Medicare beneficiaries with Alzheimer disease or 30-day readmissions to a different hospital following an admission for one of several common conditions. Methods: This was a cohort study of Medicare beneficiaries with Alzheimer disease who had one or more 30-day readmissions in 2018 following an initial admission for select Hospital Readmission Reduction Program conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia) or common reasons for hospitalization among older adults with Alzheimer disease (dehydration, syncope, urinary tract infection, or behavioral issues). Using unadjusted and adjusted logistic regression, we examined the association between electronic information sharing and in-hospital mortality during the readmission or mortality in the 30 days following the readmission. Results: A total of 28,946 admission-readmission pairs were included. Beneficiaries with same-hospital readmissions were older (aged 81.1, SD 8.6 years) than beneficiaries with readmissions to different hospitals (age range 79.8-80.3 years, P<.001). Compared to admissions and readmissions to the same hospital, beneficiaries who had a readmission to a different hospital that shared an HIE with the admission hospital had 39% lower odds of dying during the readmission (adjusted odds ratio [AOR] 0.61, 95% CI 0.39-0.95). There were no differences in in-hospital mortality observed for admission-readmission pairs to different hospitals that participated in different HIEs (AOR 1.02, 95% CI 0.82-1.28) or to different hospitals where one or both hospitals did not participate in HIE (AOR 1.25, 95% CI 0.93-1.68), and there was no association between information sharing and postdischarge mortality. Conclusions: These results indicate that information sharing between unrelated hospitals via a shared HIE may be associated with lower in-hospital, but not postdischarge, mortality for older adults with Alzheimer disease. In-hospital mortality during a readmission to a different hospital was higher if the admission and readmission hospitals participated in different HIEs or if one or both hospitals did not participate in an HIE. Limitations of this analysis include that HIE participation was measured at the hospital level, rather than at the provider level. This study provides some evidence that HIEs can improve care for vulnerable populations receiving acute care from different hospitals. %M 36897638 %R 10.2196/41936 %U https://aging.jmir.org/2023/1/e41936 %U https://doi.org/10.2196/41936 %U http://www.ncbi.nlm.nih.gov/pubmed/36897638 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43777 %T Remote Monitoring of Physiology in People Living With Dementia: An Observational Cohort Study %A David,Michael C B %A Kolanko,Magdalena %A Del Giovane,Martina %A Lai,Helen %A True,Jessica %A Beal,Emily %A Li,Lucia M %A Nilforooshan,Ramin %A Barnaghi,Payam %A Malhotra,Paresh A %A Rostill,Helen %A Wingfield,David %A Wilson,Danielle %A Daniels,Sarah %A Sharp,David J %A Scott,Gregory %+ UK Dementia Research Institute Care Research and Technology Centre, Imperial College London, 9th Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, United Kingdom, 44 (0)207 594 9010, gregory.scott99@ic.ac.uk %K dementia %K remote monitoring %K physiology %K Internet of Things %K alerts %K monitoring %K technology %K detection %K blood pressure %K support %K feasibility %K system %K quality of life %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Internet of Things (IoT) technology enables physiological measurements to be recorded at home from people living with dementia and monitored remotely. However, measurements from people with dementia in this context have not been previously studied. We report on the distribution of physiological measurements from 82 people with dementia over approximately 2 years. Objective: Our objective was to characterize the physiology of people with dementia when measured in the context of their own homes. We also wanted to explore the possible use of an alerts-based system for detecting health deterioration and discuss the potential applications and limitations of this kind of system. Methods: We performed a longitudinal community-based cohort study of people with dementia using “Minder,” our IoT remote monitoring platform. All people with dementia received a blood pressure machine for systolic and diastolic blood pressure, a pulse oximeter measuring oxygen saturation and heart rate, body weight scales, and a thermometer, and were asked to use each device once a day at any time. Timings, distributions, and abnormalities in measurements were examined, including the rate of significant abnormalities (“alerts”) defined by various standardized criteria. We used our own study criteria for alerts and compared them with the National Early Warning Score 2 criteria. Results: A total of 82 people with dementia, with a mean age of 80.4 (SD 7.8) years, recorded 147,203 measurements over 958,000 participant-hours. The median percentage of days when any participant took any measurements (ie, any device) was 56.2% (IQR 33.2%-83.7%, range 2.3%-100%). Reassuringly, engagement of people with dementia with the system did not wane with time, reflected in there being no change in the weekly number of measurements with respect to time (1-sample t-test on slopes of linear fit, P=.45). A total of 45% of people with dementia met criteria for hypertension. People with dementia with α-synuclein–related dementia had lower systolic blood pressure; 30% had clinically significant weight loss. Depending on the criteria used, 3.03%-9.46% of measurements generated alerts, at 0.066-0.233 per day per person with dementia. We also report 4 case studies, highlighting the potential benefits and challenges of remote physiological monitoring in people with dementia. These include case studies of people with dementia developing acute infections and one of a person with dementia developing symptomatic bradycardia while taking donepezil. Conclusions: We present findings from a study of the physiology of people with dementia recorded remotely on a large scale. People with dementia and their carers showed acceptable compliance throughout, supporting the feasibility of the system. Our findings inform the development of technologies, care pathways, and policies for IoT-based remote monitoring. We show how IoT-based monitoring could improve the management of acute and chronic comorbidities in this clinically vulnerable group. Future randomized trials are required to establish if a system like this has measurable long-term benefits on health and quality of life outcomes. %M 36892931 %R 10.2196/43777 %U https://aging.jmir.org/2023/1/e43777 %U https://doi.org/10.2196/43777 %U http://www.ncbi.nlm.nih.gov/pubmed/36892931 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39993 %T The Effects of Exergaming on Executive and Physical Functions in Older Adults With Dementia: Randomized Controlled Trial %A Wu,Shanshan %A Ji,Hongqing %A Won,Junyeon %A Jo,Eun-Ah %A Kim,Yun-Sik %A Park,Jung-Jun %+ Division of Sport Science, Pusan National University, 509 Kyongam Gymnasium, Busandaehak-ro 63 beon-gil 2, Geumjeong-gu, Busan, 46241, Republic of Korea, 82 051 510 2713, jjparkpnu@pusan.ac.kr %K exergame %K exergaming %K executive function %K physical function %K reaction time %K N2 %K P3b %K physical %K function %K game %K dementia %K RCT %K cognitive function %K older adults %K aerobic exercise %K exercise %K neuronal %K activity %K task %K stimulation %K intervention %D 2023 %7 7.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite increasing interest in the effects of exergaming on cognitive function, little is known about its effects on older adults with dementia. Objective: The purpose of this is to investigate the effects of exergaming on executive and physical functions in older adults with dementia compared to regular aerobic exercise. Methods: In total, 24 older adults with moderate dementia participated in the study. Participants were randomized into either the exergame group (EXG, n=13, 54%) or the aerobic exercise group (AEG, n=11, 46%). For 12 weeks, EXG engaged in a running-based exergame and AEG performed a cycling exercise. At baseline and postintervention, participants underwent the Ericksen flanker test (accuracy % and response time [RT]) while recording event-related potentials (ERPs) that included the N2 and P3b potentials. Participants also underwent the senior fitness test (SFT) and the body composition test pre- and postintervention. Repeated-measures ANOVA was performed to assess the effects of time (pre- vs postintervention), group (EXG vs AEG), and group×time interactions. Results: Compared to AEG, EXG demonstrated greater improvements in the SFT (F1.22=7.434, P=.01), reduction in body fat (F1.22=6.476, P=.02), and increase in skeletal mass (F1.22=4.525, P=.05), fat-free mass (F1.22=6.103, P=.02), and muscle mass (F1.22=6.636, P=.02). Although there was a significantly shorter RT in EXG postintervention (congruent P=.03, 95% CI 13.581-260.419, incongruent P=.04, 95% CI 14.621-408.917), no changes occurred in AEG. EXG also yielded a shorter N2 latency for central (Cz) cortices during both congruent conditions compared to AEG (F1.22=4.281, P=.05). Lastly, EXG presented a significantly increased P3b amplitude compared to AEG during the Ericksen flanker test (congruent: frontal [Fz] F1.22=6.546, P=.02; Cz F1.22=5.963, P=.23; parietal [Pz] F1.22=4.302, P=.05; incongruent: Fz F1.22=8.302, P=.01; Cz F1.22=15.199, P=.001; Pz F1.22=13.774, P=.001). Conclusions: Our results suggest that exergaming may be associated with greater improvements in brain neuronal activity and enhanced executive function task performance than regular aerobic exercise. Exergaming characterized by both aerobic exercise and cognitive stimulation can be used as an effective intervention to improve cognitive and physical functions in older adults with dementia. Trial Registration: Clinical Research Information Service KCT0008238; https://cris.nih.go.kr/cris/search/detailSearch.do/24170 %M 36881445 %R 10.2196/39993 %U https://www.jmir.org/2023/1/e39993 %U https://doi.org/10.2196/39993 %U http://www.ncbi.nlm.nih.gov/pubmed/36881445 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40785 %T A Web-Based Self-management App for Living Well With Dementia: User-Centered Development Study %A Lee,Abigail Rebecca %A Csipke,Emese %A Yates,Lauren %A Moniz-Cook,Esme %A McDermott,Orii %A Taylor,Steven %A Stephens,Michael %A Kelleher,Daniel %A Orrell,Martin %+ Institute of Mental Health, School of Medicine, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07563254838, abigail.lee19@nhs.net %K dementia %K self-management %K independence %K quality of life %K web-based %K website %K psychosocial %D 2023 %7 24.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-management, autonomy, and quality of life are key constructs in enabling people to live well with dementia. This population often becomes isolated following diagnosis, but it is important for them to feel encouraged to maintain their daily activities and stay socially active. Promoting Independence in Dementia (PRIDE) fosters social inclusion and greater dementia self-management through an interactive handbook. Objective: This study aimed to develop a paper-based PRIDE manual on a web-based platform. Methods: Two overarching stages were used to create the web-based version of PRIDE. The first was Preliminary Development, which encompassed tendering, preliminary development work, consultations, beta version of the website, user testing and consultation on beta version, and production of the final web-based prototype. The second stage was Development of the Final PRIDE App, which included 2 sprints and further user testing. Results: Through a lengthy development process, modifications were made to app areas such as the log-in process, content layout, and aesthetic appearance. Feedback from the target population was incorporated into the process to achieve a dementia-friendly product. The finished PRIDE app has defined areas for reading dementia-related topics, creating activity plans, and logging these completed activities. Conclusions: The PRIDE app has evolved from its initial prototype into a more dementia-friendly and usable program that is suitable for further testing. The finished version will be tested in a reach, effectiveness, adoption, implementation, and maintenance study, with its potential reach, effectiveness, and adoption explored. Feedback gathered during the reach, effectiveness, adoption, implementation, and maintenance study will lead to any further developments in the app to increase its applicability to the target audience and usability. %M 36826978 %R 10.2196/40785 %U https://humanfactors.jmir.org/2023/1/e40785 %U https://doi.org/10.2196/40785 %U http://www.ncbi.nlm.nih.gov/pubmed/36826978 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44627 %T Developing Early Markers of Cognitive Decline and Dementia Derived From Survey Response Behaviors: Protocol for Analyses of Preexisting Large-scale Longitudinal Data %A Jin,Haomiao %A Junghaenel,Doerte U %A Orriens,Bart %A Lee,Pey-Jiuan %A Schneider,Stefan %+ School of Health Sciences, University of Surrey, Kate Granger Building, Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 07438534086, h.jin@surrey.ac.uk %K dementia %K mild cognitive impairment %K early markers %K survey response behaviors %K epidemiology %D 2023 %7 21.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accumulating evidence shows that subtle alterations in daily functioning are among the earliest and strongest signals that predict cognitive decline and dementia. A survey is a small slice of everyday functioning; nevertheless, completing a survey is a complex and cognitively demanding task that requires attention, working memory, executive functioning, and short- and long-term memory. Examining older people’s survey response behaviors, which focus on how respondents complete surveys irrespective of the content being sought by the questions, may represent a valuable but often neglected resource that can be leveraged to develop behavior-based early markers of cognitive decline and dementia that are cost-effective, unobtrusive, and scalable for use in large population samples. Objective: This paper describes the protocol of a multiyear research project funded by the US National Institute on Aging to develop early markers of cognitive decline and dementia derived from survey response behaviors at older ages. Methods: Two types of indices summarizing different aspects of older adults’ survey response behaviors are created. Indices of subtle reporting mistakes are derived from questionnaire answer patterns in a number of population-based longitudinal aging studies. In parallel, para-data indices are generated from computer use behaviors recorded on the backend server of a large web-based panel study known as the Understanding America Study (UAS). In-depth examinations of the properties of the created questionnaire answer pattern and para-data indices will be conducted for the purpose of evaluating their concurrent validity, sensitivity to change, and predictive validity. We will synthesize the indices using individual participant data meta-analysis and conduct feature selection to identify the optimal combination of indices for predicting cognitive decline and dementia. Results: As of October 2022, we have identified 15 longitudinal ageing studies as eligible data sources for creating questionnaire answer pattern indices and obtained para-data from 15 UAS surveys that were fielded from mid-2014 to 2015. A total of 20 questionnaire answer pattern indices and 20 para-data indices have also been identified. We have conducted a preliminary investigation to test the utility of the questionnaire answer patterns and para-data indices for the prediction of cognitive decline and dementia. These early results are based on only a subset of indices but are suggestive of the findings that we anticipate will emerge from the planned analyses of multiple behavioral indices derived from many diverse studies. Conclusions: Survey response behaviors are a relatively inexpensive data source, but they are seldom used directly for epidemiological research on cognitive impairment at older ages. This study is anticipated to develop an innovative yet unconventional approach that may complement existing approaches aimed at the early detection of cognitive decline and dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/44627 %M 36809337 %R 10.2196/44627 %U https://www.researchprotocols.org/2023/1/e44627 %U https://doi.org/10.2196/44627 %U http://www.ncbi.nlm.nih.gov/pubmed/36809337 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41173 %T Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial %A Manser,Patrick %A Michels,Lars %A Schmidt,André %A Barinka,Filip %A de Bruin,Eling D %+ Motor Control and Learning Group – Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland, 41 79 519 96 46, patrick.manser@hest.ethz.ch %K cognition %K cognitive impairment %K effectiveness %K exercise %K exergame %K neuroplasticity %K neurosciences %K technology %K training %D 2023 %7 6.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components. Objective: This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called “Brain-IT”) targeted to improve cognitive functioning in older adults with mNCD. Methods: A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the “Brain-IT” training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η2p) effect sizes will be calculated for all primary and secondary outcomes. Results: Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024. Conclusions: This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization. Trial Registration: ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057 International Registered Report Identifier (IRRID): DERR1-10.2196/41173 %M 36745483 %R 10.2196/41173 %U https://www.researchprotocols.org/2023/1/e41173 %U https://doi.org/10.2196/41173 %U http://www.ncbi.nlm.nih.gov/pubmed/36745483 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43702 %T A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial %A McCarthy,Virginia %A Portz,Jennifer %A Fischer,Stacy M %A Greenway,Emily %A Johnson,Rachel L %A Knoepke,Christopher E %A Matlock,Daniel D %A Omeragic,Faris %A Peterson,Ryan A %A Ranney,Megan L %A Betz,Marian E %+ Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine Campus Box B-215, 12401 E 17th Avenue, Aurora, CO, 80045, United States, 1 3037243915, virginia.mccarthy@cuanschutz.edu %K dementia %K caregiver %K firearms %K decision aid decision-making %K Alzheimers %K ADRD %K decision %K storage %K web-based %D 2023 %7 31.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The “Safety in Dementia” (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. Objective: Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. Methods: The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. Results: The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. Conclusions: The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. Trial Registration: ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922 International Registered Report Identifier (IRRID): DERR1-10.2196/43702 %M 36719721 %R 10.2196/43702 %U https://www.researchprotocols.org/2023/1/e43702 %U https://doi.org/10.2196/43702 %U http://www.ncbi.nlm.nih.gov/pubmed/36719721 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40858 %T An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study %A Wu,Jingsong %A Tu,Jingnan %A Liu,Zhizhen %A Cao,Lei %A He,Youze %A Huang,Jia %A Tao,Jing %A Wong,Mabel N K %A Chen,Lidian %A Lee,Tatia M C %A Chan,Chetwyn C H %+ Department of Psychology, The Education University of Hong Kong, Tai Po Luk Ping Road, New Territories Hong Kong, Hong Kong, 999077, Hong Kong, 852 6318 8991, cchchan@eduhk.hk %K mild cognitive impairment %K digital assessment %K digital health %K community dwelling %K screening test %K older adults %K aging %D 2023 %7 30.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called “Efficient Online MCI Screening System” (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults. Objective: This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks. Methods: Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were “subscale item difficulty,” “discriminative index,” “internal consistency,” and “construct validity.” We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group. Results: A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, “trail making,” “clock drawing,” “cube copying,” “delayed recall”) was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach α) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95% CI 0.868-0.955). The sensitivity was 84.9%, specificity was 85.1%, and the Youden index was 0.70. Conclusions: EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903 %M 36716081 %R 10.2196/40858 %U https://www.jmir.org/2023/1/e40858 %U https://doi.org/10.2196/40858 %U http://www.ncbi.nlm.nih.gov/pubmed/36716081 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e37785 %T Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review %A Wegener,Emilie Kauffeldt %A Bergschöld,Jenny M %A Whitmore,Carly %A Winters,Marjolein %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 26202168, emilie.wegener@sund.ku.dk %K eHealth %K cognitive decline %K frail %K aging %K cocreation %K user involvement %K mobile phone %D 2023 %7 27.1.2023 %9 Review %J JMIR Hum Factors %G English %X Background: With an increase in life expectancy globally, the focus on digital health technologies that can enhance physical and mental health among older people with frailty and impairment has increased. Similarly, research interest in how digital health technology can promote well-being and self-management of health in older age has increased, including an increased focus on methods for designing digital health technologies that meet the various medical, psychological, and social needs of older population. Despite the increased focus, there remains a necessity to further understand the needs of this population group to ensure uptake and to avoid introduction of additional challenges when introducing technologies, for example, because of poor technological design. The scope is limited to digital health technologies meant to enable older people with frailty and impairment to age in place. Objective: In this study, we aimed to explore how older people with frailty and impairment are involved in various parts of the design processes of digital health technologies and identify gaps or neglected steps in a user-involving design process. This included a focus on recruitment strategies, contributions, and methods used to address the perspectives, needs, and desires of older people with frailty and impairment in the development of digital health technologies. Methods: A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting from February 2021 to April 2021. Literature searches were conducted in PubMed, Scopus, Embase, and IEEE using a search string covering the concepts of health technology, older people, frailty and impairment, user-centered design, and self-management. Results: In total, 1891 studies were imported for screening from the initial search. A total of 22 studies were included in this review after full-text screening and manual search. Invitation through partners was the most reported recruitment strategy to involve older people with frailty and impairment in the design process of digital health technologies. Furthermore, they were commonly involved in the final evaluation of the development process. Three main gaps identified were the use of outreach approaches to recruit older people with frailty and impairment in the design process of digital health technologies, description of the value of involvement and outcome of the contribution of participants, and knowledge regarding involvement in all parts of the design process. Conclusions: Although there is literature on methods for involving older people with frailty and impairment in the design of digital health technology, there is little methodological dialogue on the nuances of how different methods for involvement relate to and shape the outcome of the development process. %M 36705959 %R 10.2196/37785 %U https://humanfactors.jmir.org/2023/1/e37785 %U https://doi.org/10.2196/37785 %U http://www.ncbi.nlm.nih.gov/pubmed/36705959 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e36663 %T A Novel Digital Digit-Symbol Substitution Test Measuring Processing Speed in Adults At Risk for Alzheimer Disease: Validation Study %A Campitelli,Anthony %A Paulson,Sally %A Gills,Josh L %A Jones,Megan D %A Madero,Erica N %A Myers,Jennifer %A Glenn,Jordan M %A Gray,Michelle %+ Exercise Science Research Center, University of Arkansas, 308 HPER Building, 115 Stadium Drive, Fayetteville, AR, 72701, United States, 1 479 575 6762, rgray@uark.edu %K Alzheimer disease %K dementia %K processing speed %K digit-symbol substitution %K aging %K cognitive %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone. Objective: This study aimed to assess the concurrent validity of a novel digital PS assessment against a gold-standard measure of PS. Methods: Adults aged 45-75 years (n=191) participated in this study. Participants completed the novel digital digit-symbol substitution test (DDSST) and the Repeatable Battery for the Assessment of Neuropsychological Status coding test (RBANS-C). The correlation between the test scores was determined using a Pearson product-moment correlation, and a difference in mean test scores between tests was checked for using a 2-tailed dependent samples t test. Data were analyzed for agreement between the 2 tests using Bland-Altman limits of agreement and equivalency using a two one-sided t tests (TOST) approach. Results: A significant moderate, positive correlation was found between DDSST and RBANS-C scores (r=.577; P<.001), and no difference in mean scores was detected between the tests (P=.93). Bias was nearly zero (0.04). Scores between the tests were found to display adequate agreement with 90% of score differences falling between –22.66 and 22.75 (90% limits of agreement=–22.91 to 22.99), and the scores were equivalent (P=.049). Conclusions: Analyses indicate that the DDSST is a valid digital assessment of PS. The DDSST appears to be a suitable option for widespread, immediate, and efficient PS testing. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/ct2/show/NCT04559789 %M 36705951 %R 10.2196/36663 %U https://aging.jmir.org/2023/1/e36663 %U https://doi.org/10.2196/36663 %U http://www.ncbi.nlm.nih.gov/pubmed/36705951 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40582 %T Pioneering the Metaverse: The Role of the Metaverse in an Aging Population %A Shu,Sara %A Woo,Benjamin K P %+ Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, CA, 59905, United States, 1 858 761 7863, shus@g.ucla.edu %K metaverse %K older adult %K aging in place %K dementia %K gerontology %K geriatric %K digital health %K digital technology %K computer generated %K artificial intelligence %K virtual reality %K mixed reality %K augmented reality %K aging %K mental health %D 2023 %7 20.1.2023 %9 Viewpoint %J JMIR Aging %G English %X Amid a worldwide pandemic in the setting of an era of rapidly developing technologies, we turn now to the novel and exciting endeavor of pioneering the metaverse. Described as the conglomeration of augmented reality, virtual reality, and artificial intelligence, the metaverse has widespread applications in multiple settings, including revolutionizing health care. It also holds the potential to transform geriatric medicine, introducing new dimensions through which we can prevent social isolation, encourage health and well-being, and offer a new dimension through which we manage chronic disease. Although it is still a futuristic and novel technology, the metaverse’s realization may indeed be closer than we think. %M 36662547 %R 10.2196/40582 %U https://aging.jmir.org/2023/1/e40582 %U https://doi.org/10.2196/40582 %U http://www.ncbi.nlm.nih.gov/pubmed/36662547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42792 %T Screening of Mild Cognitive Impairment Through Conversations With Humanoid Robots: Exploratory Pilot Study %A Yoshii,Kenta %A Kimura,Daiki %A Kosugi,Akihiro %A Shinkawa,Kaoru %A Takase,Toshiro %A Kobayashi,Masatomo %A Yamada,Yasunori %A Nemoto,Miyuki %A Watanabe,Ryohei %A Ota,Miho %A Higashi,Shinji %A Nemoto,Kiyotaka %A Arai,Tetsuaki %A Nishimura,Masafumi %+ Department of Informatics, Graduate School of Intergraded Science and Technology, Shizuoka University, 3-5-1 Johoku, Naka-ku, Hamamatsu, 432-8011, Japan, 81 70 8432 8701, yoshii.kenta.14@shizuoka.ac.jp %K mild cognitive impairment %K Alzheimer disease %K neuropsychiatric symptoms %K neuropsychological assessment %K simple screening %K humanoid robot %K robot %K symptoms %K neuropsychological %K monitoring %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rising number of patients with dementia has become a serious social problem worldwide. To help detect dementia at an early stage, many studies have been conducted to detect signs of cognitive decline by prosodic and acoustic features. However, many of these methods are not suitable for everyday use as they focus on cognitive function or conversational speech during the examinations. In contrast, conversational humanoid robots are expected to be used in the care of older people to help reduce the work of care and monitoring through interaction. Objective: This study focuses on early detection of mild cognitive impairment (MCI) through conversations between patients and humanoid robots without a specific examination, such as neuropsychological examination. Methods: This was an exploratory study involving patients with MCI and cognitively normal (CN) older people. We collected the conversation data during neuropsychological examination (Mini-Mental State Examination [MMSE]) and everyday conversation between a humanoid robot and 94 participants (n=47, 50%, patients with MCI and n=47, 50%, CN older people). We extracted 17 types of prosodic and acoustic features, such as the duration of response time and jitter, from these conversations. We conducted a statistical significance test for each feature to clarify the speech features that are useful when classifying people into CN people and patients with MCI. Furthermore, we conducted an automatic classification experiment using a support vector machine (SVM) to verify whether it is possible to automatically classify these 2 groups by the features identified in the statistical significance test. Results: We obtained significant differences in 5 (29%) of 17 types of features obtained from the MMSE conversational speech. The duration of response time, the duration of silent periods, and the proportion of silent periods showed a significant difference (P<.001) and met the reference value r=0.1 (small) of the effect size. Additionally, filler periods (P<.01) and the proportion of fillers (P=.02) showed a significant difference; however, these did not meet the reference value of the effect size. In contrast, we obtained significant differences in 16 (94%) of 17 types of features obtained from the everyday conversations with the humanoid robot. The duration of response time, the duration of speech periods, jitter (local, relative average perturbation [rap], 5-point period perturbation quotient [ppq5], difference of difference of periods [ddp]), shimmer (local, amplitude perturbation quotient [apq]3, apq5, apq11, average absolute differences between the amplitudes of consecutive periods [dda]), and F0cov (coefficient of variation of the fundamental frequency) showed a significant difference (P<.001). In addition, the duration of response time, the duration of silent periods, the filler period, and the proportion of fillers showed significant differences (P<.05). However, only jitter (local) met the reference value r=0.1 (small) of the effect size. In the automatic classification experiment for the classification of participants into CN and MCI groups, the results showed 66.0% accuracy in the MMSE conversational speech and 68.1% accuracy in everyday conversations with the humanoid robot. Conclusions: This study shows the possibility of early and simple screening for patients with MCI using prosodic and acoustic features from everyday conversations with a humanoid robot with the same level of accuracy as the MMSE. %M 36637896 %R 10.2196/42792 %U https://formative.jmir.org/2023/1/e42792 %U https://doi.org/10.2196/42792 %U http://www.ncbi.nlm.nih.gov/pubmed/36637896 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40330 %T Digital Health Technology to Support Health Care Professionals and Family Caregivers Caring for Patients With Cognitive Impairment: Scoping Review %A Choukou,Mohamed-Amine %A Olatoye,Funminiyi %A Urbanowski,Reg %A Caon,Maurizio %A Monnin,Caroline %+ Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada, 1 2043334778, amine.choukou@umanitoba.ca %K digital health %K behavior change %K mental health %K cognitive impairment %D 2023 %7 11.1.2023 %9 Review %J JMIR Ment Health %G English %X Background: Digital health technology is a promising way of supporting health care providers and family caregivers as they care for patients with cognitive impairment. Objective: This scoping review aimed to portray the use of digital health technology to assist health care providers and family caregivers in caring for patients with cognitive impairment who live in the community or in a facility. Methods: We conducted a scoping review of peer-reviewed scientific articles available in MEDLINE, PsycINFO, Scopus, and CINAHL with Full Text, as well as gray literature available in preprint servers, theses depositories, and various national and international dementia organizations’ websites. The search yielded 975 articles, of which we included 7 (0.7%) in the review. Results: Of the 7 interventions included in the retrieved manuscripts, 2 (29%) were digital calendar reminder systems to support activities of daily living and medication management; 2 (29%) were apps on tablet devices to simulate the presence of family before therapy interventions; 1 (14%) was a social robot used in therapeutic sessions to include elements of musicotherapy, reminiscence, cognitive games, and relaxation; 1 (14%) was a commercially available computer system that provides access to various recreational leisure activities; and 1 (14%) was a web-based self-management support system that helps family caregivers to deal with behavior changes in a relative with dementia. Of the 7 articles, only 1 (14%) reported on the use of a behavior change theory, namely a comprehensive process model of engagement coupled with cognitive stimulation therapy. Conclusions: Literature on the topic is scarce, recent, and heterogeneous. There is a clear need for a theoretical framework to conceptualize and govern the use of behavior change models that incorporate technology for patients with cognitive impairment. %M 36630174 %R 10.2196/40330 %U https://mental.jmir.org/2023/1/e40330 %U https://doi.org/10.2196/40330 %U http://www.ncbi.nlm.nih.gov/pubmed/36630174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42416 %T Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation %A Young,Stephanie Ruth %A Lattie,Emily Gardiner %A Berry,Andrew B L %A Bui,Lynn %A Byrne,Greg Joseph %A Yoshino Benavente,Julia Noelani %A Bass,Michael %A Gershon,Richard C %A Wolf,Michael S %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, stephanieruth.young@northwestern.edu %K human-centered design %K mobile health %K mHealth %K usability %K cognitive screening %K older adults %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. %M 36626223 %R 10.2196/42416 %U https://formative.jmir.org/2023/1/e42416 %U https://doi.org/10.2196/42416 %U http://www.ncbi.nlm.nih.gov/pubmed/36626223 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e37228 %T Key Stakeholders’ Experiences and Perceptions of Virtual Reality for Older Adults Living With Dementia: Systematic Review and Thematic Synthesis %A Flynn,Aisling %A Healy,David %A Barry,Marguerite %A Brennan,Attracta %A Redfern,Sam %A Houghton,Catherine %A Casey,Dympna %+ School of Nursing and Midwifery, Aras Moyola, University of Galway, Galway, H91 TK33, Ireland, 353 91493973, a.flynn15@universityofgalway.ie %K virtual reality %K VR %K dementia %K experience %K perception %K qualitative evidence synthesis (QES) %K thematic synthesis %D 2022 %7 23.12.2022 %9 Review %J JMIR Serious Games %G English %X Background: Technology is increasingly being used and evolving in the dementia care landscape. One such technology that has gained traction over the last decade is virtual reality (VR). VR is being applied in many areas of dementia care, including cognitive assessment and training, reminiscence therapy, music therapy, and other recreational VR applications. Despite the plethora of applications, they are often not shaped by the experiences and perceptions of older adults living with dementia. Currently, there is no qualitative evidence synthesis (QES) to explore this area. This review aimed to provide qualitative evidence supporting existing systematic reviews in this area. Objective: The aim of this QES was to explore key stakeholders’ experiences and perceptions of VR for older adults living with dementia. It aimed to explore the barriers and facilitators to VR use and provide recommendations for future design and implementation. Methods: QES was used, which involved a systematic search of 6 databases to identify studies that qualitatively explored key stakeholders’ experiences and perceptions of VR for older adults living with dementia. Thematic synthesis was used to integrate the findings of 14 studies (from 15 reports). The Critical Appraisal Skills Programme tool was used to assess the methodological quality of the included studies. The confidence placed in the review findings was assessed using the GRADE-CERQUAL (Confidence in the Evidence from Reviews of Qualitative research). Results: A total of 15 reports from 14 studies were included in the review, consisting of a range of levels of VR immersion, stages of dementia, and care contexts. Three analytical themes were generated: stepping into virtuality, a virtual world, and returning to reality. The results indicate the importance of sensitively designing and introducing VR to this population, as older adults living with dementia often have no prior experience of using this technology. VR can be a positive experience for older adults living with dementia and can provide meaningful interactions, positive expressions, and long-term impacts on everyday functioning. However, it should be acknowledged that some negative associations must be accounted for before, during, and after use. Conclusions: This review highlights the positive implications as well as negative associations of VR use. It emphasizes the need for VR design and implementation driven by the needs and views of older adults living with dementia as well as with other key stakeholders. Future research needs to explore the vital role that older adults living with dementia can play in the design process and how they can be empowered to meaningfully design and use this technology. %M 36563042 %R 10.2196/37228 %U https://games.jmir.org/2022/4/e37228 %U https://doi.org/10.2196/37228 %U http://www.ncbi.nlm.nih.gov/pubmed/36563042 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42886 %T Association Between Acoustic Features and Neuropsychological Test Performance in the Framingham Heart Study: Observational Study %A Ding,Huitong %A Mandapati,Amiya %A Karjadi,Cody %A Ang,Ting Fang Alvin %A Lu,Sophia %A Miao,Xiao %A Glass,James %A Au,Rhoda %A Lin,Honghuang %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 7744554881, honghuang.lin@umassmed.edu %K mild cognitive impairment %K digital voice %K neuropsychological test %K association %K prediction %D 2022 %7 22.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Human voice has increasingly been recognized as an effective indicator for the detection of cognitive disorders. However, the association of acoustic features with specific cognitive functions and mild cognitive impairment (MCI) has yet to be evaluated in a large community-based population. Objective: This study aimed to investigate the association between acoustic features and neuropsychological (NP) tests across multiple cognitive domains and evaluate the added predictive power of acoustic composite scores for the classification of MCI. Methods: This study included participants without dementia from the Framingham Heart Study, a large community-based cohort with longitudinal surveillance for incident dementia. For each participant, 65 low-level acoustic descriptors were derived from voice recordings of NP test administration. The associations between individual acoustic descriptors and 18 NP tests were assessed with linear mixed-effect models adjusted for age, sex, and education. Acoustic composite scores were then built by combining acoustic features significantly associated with NP tests. The added prediction power of acoustic composite scores for prevalent and incident MCI was also evaluated. Results: The study included 7874 voice recordings from 4950 participants (age: mean 62, SD 14 years; 4336/7874, 55.07% women), of whom 453 were diagnosed with MCI. In all, 8 NP tests were associated with more than 15 acoustic features after adjusting for multiple testing. Additionally, 4 of the acoustic composite scores were significantly associated with prevalent MCI and 7 were associated with incident MCI. The acoustic composite scores can increase the area under the curve of the baseline model for MCI prediction from 0.712 to 0.755. Conclusions: Multiple acoustic features are significantly associated with NP test performance and MCI, which can potentially be used as digital biomarkers for early cognitive impairment monitoring. %M 36548029 %R 10.2196/42886 %U https://www.jmir.org/2022/12/e42886 %U https://doi.org/10.2196/42886 %U http://www.ncbi.nlm.nih.gov/pubmed/36548029 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e40357 %T Impact and Perceived Value of iGeriCare e-Learning Among Dementia Care Partners and Others: Pilot Evaluation Using the IAM4all Questionnaire %A Scott,Andrew F %A Ayers,Stephanie %A Pluye,Pierre %A Grad,Roland %A Sztramko,Richard %A Marr,Sharon %A Papaioannou,Alexandra %A Clark,Sandra %A Gerantonis,Patricia %A Levinson,Anthony J %+ Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 905 525 9140 ext 22210, levinsa@mcmaster.ca %K dementia %K caregiver %K web-based education %K internet %K consumer health information %K feedback %K perception %K survey %K questionnaire %K patient education %K health education %K care partner %K caregiving %K spousal care %K informal care %K Alzheimer %K cognitive impairment %K cognitively impaired %K Lewy body %K gerontology %K geriatric %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Care partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia. Objective: Our objective was to evaluate users’ perceptions of impact. Methods: From March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28). Results: A total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something. Conclusions: Users identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress. %M 36150051 %R 10.2196/40357 %U https://aging.jmir.org/2022/4/e40357 %U https://doi.org/10.2196/40357 %U http://www.ncbi.nlm.nih.gov/pubmed/36150051 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e43098 %T Development of a Home-Based Stress Management Toolkit for Dementia Caring Dyads: Protocol for a Pilot Intervention Development and Feasibility Study %A Harris,Melissa %A Van Houtven,Courtney %A Hastings,Susan %+ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, 411 W Chapel Hill St, Durham, NC, 27701, United States, 1 405 513 1271, Melissa.L.Harris@Duke.edu %K dementia %K stress %K caregiver %K dyad %K intervention %K nonpharmacologic %D 2022 %7 14.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People living with dementia (PLWD) and their care partners (dementia caring dyads) are at a heightened risk of experiencing stress-related symptoms and conditions. Yet, many dyadic stress management interventions have had limited uptake by health care systems and in the community. An intervention that combines simple, safe, easy-to-use, nonpharmacologic tools (eg, animatronic social pets, weighted blankets and garments, aromatherapy and bright light therapy devices, acupressure, and massage tools) that can be used in the home may be a promising approach to promote stress management among dementia caring dyads. Objective: The proposed study aims to develop and user test a dyadic toolkit intervention composed of simple, tangible stress management tools for community-dwelling PLWD and their care partners. This study will also explore the feasibility of collecting several stress-related outcome measures to inform measurement selection for future studies. Methods: A human-centered design (HCD) approach will be used to increase the likelihood of developing an intervention that will be translatable to real-world settings. This study consists of 2 phases. The first phase will address the discover, define, and design stages of HCD using qualitative focus groups with dementia caring dyads (N=12-16 dyads). Dyadic focus groups (3-4 groups anticipated) will be convened to understand participants’ stress experiences and to co-design a stress management toolkit prototype. Rapid qualitative analysis will be used to analyze focus group data. In phase 2, the toolkit prototype will be user tested for 2 weeks in a new sample to address the validation step of HCD. A within-subjects (n=10 dyads), pre-post design will be used with measures of usability (frequency of toolkit use), feasibility (enrollment and withdrawal rates, adverse events/injuries), and acceptability (satisfaction, benefit) collected via questionnaires (at the end of weeks 1 and 2 of user testing) and focus groups (n=3-4 dyads/group at the end of week 2). The feasibility of collecting participant-reported, stress-related outcomes (neuropsychiatric symptoms of dementia, caregiver stress, dyadic relationship strain) and salivary cortisol as a physiologic measure of stress will be assessed at baseline and after user testing. Results: This study will yield a working prototype of a stress management toolkit for dementia caring dyads, as well as preliminary data to support the feasibility and acceptability of the intervention. User testing will elucidate areas to refine the prototype and provide data to inform preliminary testing of the intervention. As of September 2022, this study has received institutional ethics board approval with phase 1 recruitment anticipated to begin January 2023. Conclusions: Few interventions have focused on combining simple, safe, low burden tools to promote stress management among community-dwelling dementia caring dyads. By involving families and exploring feasibility and acceptability at the onset of development, this intervention will have greater potential to be implemented and sustained in the future. Trial Registration: ClinicalTrials.gov NCT05465551; https://clinicaltrials.gov/ct2/show/NCT05465551 International Registered Report Identifier (IRRID): PRR1-10.2196/43098 %M 36399169 %R 10.2196/43098 %U https://www.researchprotocols.org/2022/12/e43098 %U https://doi.org/10.2196/43098 %U http://www.ncbi.nlm.nih.gov/pubmed/36399169 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e42731 %T Nurse-Led Virtual Delivery of PIECES in Canadian Long-Term Care Homes to Support the Care of Older Adults Experiencing Responsive Behaviors During COVID-19: Qualitative Descriptive Study %A Garnett,Anna %A Connelly,Denise %A Yous,Marie-Lee %A Hung,Lillian %A Snobelen,Nancy %A Hay,Melissa %A Furlan-Craievich,Cherie %A Snelgrove,Shannon %A Babcock,Melissa %A Ripley,Jacqueline %A Hamilton,Pam %A Sturdy-Smith,Cathy %A O’Connell,Maureen %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 519 661 2111, agarnet6@uwo.ca %K long-term care %K older adults %K families %K responsive behaviors %K qualitative %K COVID-19 %K PIECES %K nurse(s) %K care home %K infection %K therapeutic %K anxiety %K depression %K cognitive %K fear %K death %K dementia %K communication %K technology %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes, including isolating older adults in their rooms, canceling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviors (eg, yelling, hitting, calling out) to express frustration, fear, restricted movement, and boredom. To respond to the challenges in LTC and support frontline staff, older adults, and family members, a novel registered practical nurse (RPN)-led delivery of the PIECES approach for addressing responsive behaviors among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECES employs a person- and family/care partner–centered collaborative team-based approach to provide education and capacity-building for nurses; engages families as active participants in care; and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs, including dementia. Objective: The aim of this study was to describe the experiences of LTC staff, family/care partners, and older adult research partners with implementation of a novel RPN-led virtual adaptation of the PIECES care-planning approach for responsive behaviors in two Canadian LTC homes during the COVID-19 pandemic. Methods: Using a qualitative descriptive design, two focus groups were held with three to four staff members (eg, RPNs, managers) per LTC home in Ontario. A third focus group was held with three PIECES mentors. Individual semistructured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was performed. Results: A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration, and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences. Conclusions: These findings offer promising support to adopting virtual PIECES, a team approach to gather valuable family input and engagement to address residents’ unmet needs and responsive behaviors in LTC. Future research should investigate a hybridized communication format to foster sustainable person- and family-centered care-planning practices to include active collaboration of families in individualized care plans. %M 36446050 %R 10.2196/42731 %U https://nursing.jmir.org/2022/1/e42731 %U https://doi.org/10.2196/42731 %U http://www.ncbi.nlm.nih.gov/pubmed/36446050 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e38656 %T Lessons Learned From an Effectiveness Evaluation of Inlife, a Web-Based Social Support Intervention for Caregivers of People With Dementia: Randomized Controlled Trial %A Christie,Hannah Liane %A Dam,Alieske Elisabeth Henrike %A van Boxtel,Martin %A Köhler,Sebastian %A Verhey,Frans %A de Vugt,Marjolein Elisabeth %+ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 456213078, hannah.christie@maastrichtuniversity.nl %K dementia %K Alzheimer's %K neurodegenerative %K caregiver %K caregiving %K digital health %K eHealth %K mHealth %K Information communication technology %K RCT %K randomized controlled trial %K social support %K support platform %K online platform %K web-based %K internet-based %K peer-support %K informal support %K social interaction %K support network %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Informal care for people with dementia not only affects the well-being of the primary caregiver but also changes their roles and interactions with the social environment. New online interventions might facilitate access to social support. Recently, an online social support platform, Inlife, was developed in the Netherlands and aims to enhance social support and positive interactions in informal support networks. Objective: This study aimed to evaluate the effectiveness of Inlife for caregivers of people with dementia. Methods: A randomized controlled trial with 96 caregivers of people with dementia was performed. Participants were randomly assigned to the Inlife intervention or the waiting list control group. After 16 weeks of Inlife use, the waiting list control group could start using Inlife. Effects were evaluated at baseline (T0), 8 weeks (T1), and 16 weeks (T2). The 16-week follow-up assessment (T2) served as the primary endpoint to evaluate the results for the primary and secondary outcome variables evaluated with online self-report questionnaires. The primary outcomes included feelings of caregiver competence and perceived social support. The secondary outcomes included received support, feelings of loneliness, psychological complaints (eg, anxiety, stress), and quality of life. Results: No significant improvements were demonstrated for the intervention group (n=48) relative to the control group (n=48) for the primary outcomes (feeling of carer competence: b=–0.057, 95% CI –0.715 to 0.602, P=.87; perceived social support: b=–15.877, 95% CI –78.284 to 46.530, P=.62) or any secondary outcome. This contrasts with our qualitative findings showing the potential of Inlife to facilitate the care process in daily life. Adherence was not optimal for all Inlife users. Additional per-protocol and sensitivity analyses also revealed no beneficial results for high active Inlife users or specific subgroups. Inlife users were more active when part of a larger network. Conclusions: Researchers should be modest regarding the effectiveness of online caregiver interventions in terms of quantitative measures of well-being and quality of life. Nevertheless, online tools have the potential to facilitate the caregiver process in daily life. Lessons learned include the importance of harnessing the power of human interaction in eHealth, making use of the user’s social capital, and the need to develop research methods that can identify benefits in daily life that are ecologically valid for caregivers. Trial Registration: Netherlands Trial Register NTR6131; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6131 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-017-2097-y %M 36476485 %R 10.2196/38656 %U https://aging.jmir.org/2022/4/e38656 %U https://doi.org/10.2196/38656 %U http://www.ncbi.nlm.nih.gov/pubmed/36476485 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e40360 %T Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives %A Seah,Cassandra E L %A Zhang,Zheyuan %A Sun,Sijin %A Wiskerke,Esther %A Daniels,Sarah %A Porat,Talya %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 9EG, United Kingdom, 44 7742540443, c.seah@imperial.ac.uk %K mindfulness %K dyadic %K dementia %K caregivers %K user needs %K intervention %K mindfulness %K user %K feedback %K design %K accessibility %K relationships %K mindset %K essential %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. %M 36472897 %R 10.2196/40360 %U https://aging.jmir.org/2022/4/e40360 %U https://doi.org/10.2196/40360 %U http://www.ncbi.nlm.nih.gov/pubmed/36472897 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 1 %N 1 %P e39974 %T Remote Consultations for People With Parkinson Disease and Cognitive Impairment: Interview Study With Patients, Caregivers, and Health Care Professionals %A Pigott,Jennifer Sarah %A Armstrong,Megan %A Chesterman,Elizabeth %A Read,Joy %A Nimmons,Danielle %A Walters,Kate %A Davies,Nathan %A Schrag,Anette %+ Queen Square Institute of Neurology, University College London, Neurology Department, U3 Floor, Royal Free Hospital, London, NW3 2PF, United Kingdom, 44 2080168132, j.pigott@ucl.ac.uk %K remote consultations %K telehealth %K telemedicine %K Parkinson disease %K cognitive impairment %K Parkinson dementia %K neurodegenerative condition %K telephone appointments %K video appointments %K qualitative %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Neurotech %G English %X Background: The COVID-19 pandemic led to many consultations being conducted remotely. Cognitive impairment is recognized as a potential barrier to remote health care interactions and is common and heterogeneous in Parkinson disease. Studies have shown remote consultations in Parkinson disease to be feasible, but little is known about real-life experience, especially for those with cognitive impairment. We explored the experiences and perceptions of remote consultations for people with Parkinson disease and cognitive impairment. Objective: This study aimed to explore the experiences of remote consultations for people with Parkinson disease and cognitive impairment from the perspective of service users and professionals and investigate considerations for future service delivery. Methods: Semistructured interviews were conducted remotely with 11 people with Parkinson disease and cognitive impairment, 10 family caregivers, and 24 health care professionals (HCPs) between 2020 and 2021. Purposive sampling was used. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Results: Overall, four themes were identified: “the nature of remote interactions,” “challenges exacerbated by being remote,” “expectation versus reality,” and “optimizing for the future.” Remote consultations were considered as “transactional” and less personal, with difficulties in building rapport, and considered to play a different role from that of in-person consultations. The loss of nonverbal communication and ability of HCPs to sense led to remote consultations being perceived as riskier by all groups. Issues arising from communication and cognitive impairment, balancing the voices of the person with Parkinson disease and the caregiver, and discussions of the future affect this population specifically. Remote consultations were reported to have been more successful than anticipated in all 3 groups. Obstacles were not always as expected; for example, age was less of a barrier than predicted. Video consultations were perceived as being preferable to telephone consultations by many participants, but not accessible to all people with Parkinson disease. With widespread expectation of ongoing remote consultations, potential improvements for these 3 groups and health care services were identified, including practice, preparation, increased awareness of issues, expectation management by HCPs, and more time and flexibility for consultations. Conclusions: Advantages and challenges of remote consultations for this population are identified. Consultations could be improved with increased support, practice, preparation, awareness of issues, and more time and flexibility within services. %R 10.2196/39974 %U https://neuro.jmir.org/2022/1/e39974 %U https://doi.org/10.2196/39974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39199 %T End Users’ and Other Stakeholders’ Needs and Requirements in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People With Dementia or Parkinson Disease: Mixed Methods Study %A Ahmed,Mona %A Marín,Mayca %A How,Daniella %A Judica,Elda %A Tropea,Peppino %A Bentlage,Ellen %A J Ferreira,Joaquim %A Bouça-Machado,Raquel %A Brach,Michael %+ Institute of Sport and Exercise Sciences, Münster University, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 25183 ext 34812, mona.ahmad@uni-muenster.de %K neurodegenerative %K Parkinson disease %K dementia %K chronic diseases %K health care technologies %K integrated care %K information and communication technology %K ICT %K user-centered design %K mobile phone %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With what has been known as the “triple-win effect”, introducing information and communication technologies (ICTs) in the health care of neurodegenerative diseases is beneficial in delaying the need for institutional care, reducing the associated health care costs, reducing the caregiving burden, and improving individuals’ quality of life. Nevertheless, the mismatch between the users’ expectations and their actual needs remains one of the main challenges that can reduce the usability of technology solutions. Therefore, the European project Personalized Integrated Care Promoting Quality of Life for Older People (PROCare4Life), which aimed to develop an ICT-based platform for all parties involved in the health care of neurodegenerative diseases, adopted a user-centered design approach, where all users are involved from the inception and throughout the platform development and implementation to integrate their needs and requirements in the proposed platform. Objective: This paper presents the results of a study on the needs and requirements of the potential end users (older people with neurodegenerative diseases, caregivers, and health care professionals) and other key stakeholders in the development of the PROCare4Life platform. Methods: A mixed qualitative and quantitative study design was used, including 2 web-based surveys, 40 interviews, and 4 workshops. The study was conducted between April and September 2020 in 5 European countries: Germany, Italy, Portugal, Romania, and Spain. Both data types were analyzed separately and then merged and interpreted, with greater priority placed on qualitative research. Results: A total of 217 participants were recruited; 157 (72.4%) of them completed the web-based surveys (n=85, 54.1% patients and n=72, 45.9% caregivers), and 60 (27.6%) individuals participated in the qualitative research (20/60, 33% health care professionals; 5/60, 8% patients; 5/60, 8% caregivers; and 30/60, 50% key stakeholders). We identified 3 main themes (T): (T1) experiences associated with illness, (T2) thoughts about the platform technology, and (T3) desired properties. Alerts for adverse events, communication tools, reminders, and monitoring are constantly needed functionalities, whereas ease of use, personalization, and user-friendliness are foreseen as necessary features. Conclusions: This paper identified the key personal, social, and health factors that influence the daily lives of the potential end users and reflected on their needs and expectations regarding the design of the proposed PROCare4Life platform. The collected data were useful for the development of the PROCare4Life platform. Although the combination and collection of features for diverse user groups are typical for integrated care platforms, it results in exponential complexity for designers, developers, and users. Contradicting opinions and several concerns in this study demonstrate that an ICT-integrated care platform should not promise too much for too many. Instead, selection, focus, and, sometimes, restriction to essentials are necessary. Users and other stakeholders should be involved in these decisions. International Registered Report Identifier (IRRID): RR2-10.2196/22463 %M 36449340 %R 10.2196/39199 %U https://formative.jmir.org/2022/11/e39199 %U https://doi.org/10.2196/39199 %U http://www.ncbi.nlm.nih.gov/pubmed/36449340 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e42577 %T Reorganizing Pharmaceutical Care in Family Medicine Groups for Older Adults With or at Risk of Major Neurocognitive Disorders: Protocol for a Mixed Methods Study %A Guénette,Line %A Kröger,Edeltraut %A Bonnan,Dylan %A Maheu,Anne %A Morin,Michèle %A Bélanger,Laurianne %A Vedel,Isabelle %A Wilchesky,Machelle %A Sirois,Caroline %A Durand,Etienne %A Couturier,Yves %A Sourial,Nadia %A Dallaire,Clémence %+ Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, 1050 chemin Ste-Foy, J1-08, Québec, QC, G1S 4L8, Canada, 1 418 682 7511 ext 84694, line.guenette@pha.ulaval.ca %K primary care %K older adults %K neurocognitive disorders %K pharmaceutical care %K mixed method study %D 2022 %7 17.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults’ pharmacotherapy are opening. Objective: This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers. Methods: This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients’ care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. Results: Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention’s impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. Conclusions: The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. Trial Registration: ClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794 International Registered Report Identifier (IRRID): DERR1-10.2196/42577 %M 36264995 %R 10.2196/42577 %U https://www.researchprotocols.org/2022/11/e42577 %U https://doi.org/10.2196/42577 %U http://www.ncbi.nlm.nih.gov/pubmed/36264995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37496 %T A Psychosocial Intervention for Supporting Informal Caregivers of Older People With Alzheimer Disease: Protocol for the InnFamiglia Randomized Controlled Trial %A Pasquini,Sara %A Margaritini,Arianna %A Gambella,Elena %A Di Rosa,Mirko %A Maranesi,Elvira %A Bevilacqua,Roberta %A Civerchia,Patrizia %A Pelliccioni,Giuseppe %+ IRCCS INRCA, Via Santa Margherita 5, Ancona, 60124, Italy, 39 0718004767, r.bevilacqua@inrca.it %K Alzheimer disease %K caregiver burden %K psychosocial intervention %K self-help %K emotional support %K randomized controlled trial %K dementia %D 2022 %7 11.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a neurodegenerative syndrome characterized by impaired cognitive functions associated with psychological and behavioral disorders. The informal caregiver has a central role in the life of the person with dementia. Committing a large part of the day to caring for the assisted person inevitably has an effect on the caregiver’s life. Objective: The aim of this study is to analyze the impact of a psychosocial intervention dedicated to a group of informal caregivers of patients with Alzheimer disease. The intervention will be guided by a trained psychologist who will facilitate the participants’ expression of their emotional states, as compared to a traditional self-help group. Methods: The intervention described in this paper was designed and developed for the project INNovazione sociale e tecnologica per le FAMIGLIE che assistono malati affetti da Alzheimer (InnFamiglia). The study is designed as a randomized controlled trial (RCT). The RCT includes an experimental group, in which the participants will undertake the psychosocial intervention, and a control group, where participants will receive support according to traditional self-help methodology. Interventions for both groups will last 4 months and will be comprised of 16 sessions. Results: Participant recruitment, enrollment, and data collection began in 2021. Enrollment continued until September 2022, at which time the last group began the intervention. Data collection will be completed by December 2022, and data analysis will be completed by March 2023. The study findings will be published in peer-reviewed scientific journals and will be presented at scientific meetings. Summaries of the results will also be made available to investigators for dissemination within their clinics. Conclusions: We hypothesize that the experimental group will be more effective in managing caregiver burden and coping strategies and that this will improve the perception of well-being, anxiety, and depression among caregivers. Our study aims to compare two groups receiving different interventions: a self-help group and a psychosocial group with elements of emotional support. This study may also give us more information about the most appropriate ways to support and help caregivers of people with dementia. International Registered Report Identifier (IRRID): DERR1-10.2196/37496 %M 36367770 %R 10.2196/37496 %U https://www.researchprotocols.org/2022/11/e37496 %U https://doi.org/10.2196/37496 %U http://www.ncbi.nlm.nih.gov/pubmed/36367770 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e41015 %T Existing eHealth Solutions for Older Adults Living With Neurocognitive Disorders (Mild and Major) or Dementia and Their Informal Caregivers: Protocol for an Environmental Scan %A Jose,Ambily %A Sasseville,Maxime %A Dequanter,Samantha %A Gorus,Ellen %A Giguère,Anik %A Bourbonnais,Anne %A Abbasgholizadeh Rahimi,Samira %A Buyl,Ronald %A Gagnon,Marie-Pierre %+ Faculty of Nursing Sciences, Universite Laval, 1050, avenue de la Medecine, Quebec City, QC, G1V0A6, Canada, 1 418 656 2131 ext 407576, marie-pierre.gagnon@fsi.ulaval.ca %K dementia %K eHealth solutions %K mild cognitive impairment (MCI) %K environmental scan %K digital health %D 2022 %7 4.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is one of the main public health priorities for current and future societies worldwide. Over the past years, eHealth solutions have added numerous promising solutions to enhance the health and wellness of people living with dementia-related cognitive problems and their primary caregivers. Previous studies have shown that an environmental scan identifies the knowledge-to-action gap meaningfully. This paper presents the protocol of an environmental scan to monitor the currently available eHealth solutions targeting dementia and other neurocognitive disorders against selected attributes. Objective: This study aims to identify the characteristics of currently available eHealth solutions recommended for older adults with cognitive problems and their informal caregivers. To inform the recommendations regarding eHealth solutions for these people, it is important to obtain a comprehensive view of currently available technologies and document their outcomes and conditions of success. Methods: We will perform an environmental scan of available eHealth solutions for older adults with cognitive impairment or dementia and their informal caregivers. Potential solutions will be initially identified from a previous systematic review. We will also conduct targeted searches for gray literature on Google and specialized websites covering the regions of Canada and Europe. Technological tools will be scanned based on a preformatted extraction grid. The relevance and efficiency based on the selected attributes will be assessed. Results: We will prioritize relevant solutions based on the needs and preferences identified from a qualitative study among older adults with cognitive impairment or dementia and their informal caregivers. Conclusions: This environmental scan will identify eHealth solutions that are currently available and scientifically appraised for older adults with cognitive impairment or dementia and their informal caregivers. This knowledge will inform the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate eHealth solutions according to their needs and preferences based on trustable information. International Registered Report Identifier (IRRID): DERR1-10.2196/41015 %M 36331531 %R 10.2196/41015 %U https://www.researchprotocols.org/2022/11/e41015 %U https://doi.org/10.2196/41015 %U http://www.ncbi.nlm.nih.gov/pubmed/36331531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40049 %T Examining the Twitter Discourse on Dementia During Alzheimer’s Awareness Month in Canada: Infodemiology Study %A Bacsu,Juanita-Dawne %A Cammer,Allison %A Ahmadi,Soheila %A Azizi,Mehrnoosh %A Grewal,Karl S %A Green,Shoshana %A Gowda-Sookochoff,Rory %A Berger,Corinne %A Knight,Sheida %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K Twitter %K social media %K dementia %K Alzheimer disease %K awareness %K public health campaigns %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Twitter has become a primary platform for public health campaigns, ranging from mental health awareness week to diabetes awareness month. However, there is a paucity of knowledge about how Twitter is being used during health campaigns, especially for Alzheimer’s Awareness Month. Objective: The purpose of our study was to examine dementia discourse during Canada’s Alzheimer’s Awareness Month in January to inform future awareness campaigns. Methods: We collected 1289 relevant tweets using the Twint application in Python from January 1 to January 31, 2022. Thematic analysis was used to analyze the data. Results: Guided by our analysis, 4 primary themes were identified: dementia education and advocacy, fundraising and promotion, experiences of dementia, and opportunities for future actions. Conclusions: Although our study identified many educational, promotional, and fundraising tweets to support dementia awareness, we also found numerous tweets with cursory messaging (ie, simply referencing January as Alzheimer’s Awareness Month in Canada). While these tweets promoted general awareness, they also highlight an opportunity for targeted educational content to counter stigmatizing messages and misinformation about dementia. In addition, awareness strategies partnering with diverse stakeholders (such as celebrities, social media influencers, and people living with dementia and their care partners) may play a pivotal role in fostering dementia dialogue and education. Further research is needed to develop, implement, and evaluate dementia awareness strategies on Twitter. Increased knowledge, partnerships, and research are essential to enhancing dementia awareness during Canada’s Alzheimer’s Awareness Month and beyond. %M 36287605 %R 10.2196/40049 %U https://formative.jmir.org/2022/10/e40049 %U https://doi.org/10.2196/40049 %U http://www.ncbi.nlm.nih.gov/pubmed/36287605 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e36607 %T Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial %A Chodosh,Joshua %A Connor,Karen %A Fowler,Nicole %A Gao,Sujuan %A Perkins,Anthony %A Grudzen,Corita %A Messina,Frank %A Mangold,Michael %A Smilowitz,Jessica %A Boustani,Malaz %A Borson,Soo %+ Division of Geriatrics and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, Translational Research Building 839, 227 East 30th street, New York, NY, 10016, United States, 1 212 268 6768, joshua.chodosh@nyulangone.org %K emergency department %K cognitive impairment %K dementia %K care management %K root cause analysis %D 2022 %7 20.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective: We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients (POISED) trial, compared with usual care. We described the research design, intervention, outcome measures, data collection techniques, and analysis plans. Methods: Emergency department patients who were aged ≥75 years and screened positive for cognitive impairment via either the Mini-Cog or the proxy-reported Short Informant Questionnaire on Cognitive Decline in the Elderly, with a planned discharge to home, were recruited to participate with their identified informal (family or friend) caregiver in the 2-site POISED randomized controlled trial at New York University Langone Health and Indiana University. The intervention group received 6 months of care management from the POISED Care Team of registered nurses and specialty-trained paraprofessionals, who perform root cause analyses, administer standardized assessments, provide advice, recommend appropriate referrals, and, when applicable, implement dementia-specific comorbid condition protocols. The control group received care as recommended at emergency department discharge (usual care) and were given information about resources for further cognitive assessment. The primary outcome is repeat emergency department use; secondary outcomes include caregiver activation for patient health care management, caregiver depression, anxiety, and experience of social support as important predisposing and time-varying enabling and need characteristics. Data were collected from questionnaires and patients’ electronic health records. Results: Recruitment was conducted between March 2018 and May 2021. Study findings will be published in peer-reviewed journals and presented to peer audiences, decision makers, stakeholders, and other interested persons. Conclusions: The POISED intervention is a promising approach to tailoring care management based on root causes for emergency department admission of patients with cognitive impairment with the aim of reducing readmissions. This trial will provide insights for caregivers and emergency department and primary care providers on appropriate, personalized, and proactive treatment plans for older adults with cognitive impairment. The findings will be relevant to audiences concerned with quality of life for individuals with cognitive impairment and their caregivers. Trial Registration: ClinicalTrials.gov NCT03325608; https://clinicaltrials.gov/ct2/show/NCT03325608 International Registered Report Identifier (IRRID): DERR1-10.2196/36607 %M 36264626 %R 10.2196/36607 %U https://www.researchprotocols.org/2022/10/e36607 %U https://doi.org/10.2196/36607 %U http://www.ncbi.nlm.nih.gov/pubmed/36264626 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39513 %T Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Older Adults: Protocol Development and Usability Study %A Christova,Monica %A Strohmaier,Robert %A Fuchs-Neuhold,Bianca %A Guggenberger,Bernhard %A Loder-Fink,Brigitte %A Draxler,Theresa %A Palli,Christoph %A Simi,Helmut %A Schadenbauer,Sandra %A Nischelwitzer,Alexander %A Sprung,Gerhard %A Pilz,René %A Darkow,Robert %A Staubmann,Wolfgang %+ Institute of Physiotherapy, University of Applied Sciences FH JOANNEUM, Eggenberger Allee 13, Graz, 8020, Austria, 43 316 5453 6552, monica.christova@fh-joanneum.at %K augmented reality %K virtual reality %K multimodal screening %K cognitive impairment %K smart cognition %K elderly %K usability %K dementia %K aging %K screening tool %K digital health %K digital health intervention %D 2022 %7 14.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. Objective: This study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. Methods: This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. Results: This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. Conclusions: The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. International Registered Report Identifier (IRRID): DERR1-10.2196/39513 %M 36239994 %R 10.2196/39513 %U https://www.researchprotocols.org/2022/10/e39513 %U https://doi.org/10.2196/39513 %U http://www.ncbi.nlm.nih.gov/pubmed/36239994 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38192 %T Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint %A Temprado,Jean-Jacques %A Torre,Marta Maria %+ Aix Marseille Université, Institut des Sciences du Mouvement, 163 Avenue de Luminy, BP 910, Marseille, 13288, France, 33 611837288, jean-jacques.temprado@univ-amu.fr %K aging %K older %K gerontology %K exergame %K physical activity %K cognition %K training %K intervention %K cognitive %K brain %K older adult %K motor skills %K exercise %K physical %K motor %K combined training %D 2022 %7 3.10.2022 %9 Viewpoint %J JMIR Serious Games %G English %X Combining physical, motor, and cognitive exercises is expected to be effective to attenuate age-related declines of brain and cognition in older adults. This can be achieved either by conventional interventions or by exergames. This paper aimed to determine whether conventional combined training and exergame interventions are two comparable ways for delivering combined training. In total, 24 studies on conventional training and 23 studies on exergames were selected and compared. A common framework was used to analyze both types of combined training interventions. Our analysis showed that conventional combined training interventions were more effective than separated physical and motor training to improve brain and cognition, while their superiority over cognitive training alone remains to be confirmed. Exergames scarcely led to cognitive benefits superior to those observed after physical, motor, or cognitive training alone. Thus, although both conventional training interventions and exergames allowed delivering combined training programs, they are not two facets of the same coin. Further studies that are more theoretically grounded are necessary to determine whether interventions delivered via exergames may lead to superior benefits compared to conventional separated and combined training interventions. %M 36190757 %R 10.2196/38192 %U https://games.jmir.org/2022/4/e38192 %U https://doi.org/10.2196/38192 %U http://www.ncbi.nlm.nih.gov/pubmed/36190757 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e37090 %T Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study %A Skirrow,Caroline %A Meszaros,Marton %A Meepegama,Udeepa %A Lenain,Raphael %A Papp,Kathryn V %A Weston,Jack %A Fristed,Emil %+ Novoic Ltd, Wenlock Studios, Office G.05, 50-52 Wharf Road, Islington, London, N1 7EU, United Kingdom, 44 7759 093006, caroline@novoic.com %K neurology %K memory %K episodic %K speech %K psychometrics %K reliability %K validity %K aging %K elder %K older adult %K Alzheimer disease %K mild cognitive impairment %K mobile apps %K mobile health %K mHealth %K smartphone %K cognition %K cognitive decline %K cognitive impairment %K development %K validation %K recall %K memory %K story %K stories %K observational study %K acceptability %K usability %K semantic %K cognitive test %K speech %K linguistic %K mobile phone %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring. Objective: This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD. Methods: The “Amyloid Prediction in Early Stage Alzheimer’s disease” (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants’ personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer’s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire. Results: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)—78 cognitively unimpaired (CU) and 73 MCI or mild AD—engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests. Conclusions: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring. %M 36178715 %R 10.2196/37090 %U https://aging.jmir.org/2022/3/e37090 %U https://doi.org/10.2196/37090 %U http://www.ncbi.nlm.nih.gov/pubmed/36178715 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e40171 %T A Social Media–Based Intervention for Chinese American Caregivers of Persons With Dementia: Protocol Development %A Hong,Y Alicia %A Shen,Kang %A Lu,Huixing Kate %A Chen,Hsiaoyin %A Gong,Yang %A Ta Park,Van %A Han,Hae-Ra %+ Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Dr. MS 1j3, Fairfax, VA, 22030, United States, 1 703 993 1929, yhong22@gmu.edu %K Alzheimer disease %K dementia %K caregivers %K Chinese Americans %K mHealth intervention %K mobile health %K WeChat %K social media %K aging %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Racial/ethnic minority and immigrant caregivers of persons with dementia experience high rates of psychosocial stress and adverse health outcomes. Few culturally tailored mobile health (mHealth) programs were designed for these vulnerable populations. Objective: This study reports the development of a culturally tailored mHealth program called Wellness Enhancement for Caregivers (WECARE) to improve caregiving skills, reduce distress, and improve the psychosocial well-being of Chinese American family caregivers of persons with dementia. Methods: Community-based user-centered design principles were applied in the program development. First, the structure and curriculum of the WECARE program were crafted based on existing evidence-based interventions for caregivers with input from 4 experts. Second, through working closely with 8 stakeholders, we culturally adapted evidence-based programs into multimedia program components. Lastly, 5 target users tested the initial WECARE program; their experience and feedback were used to further refine the program. Results: The resulting WECARE is a 7-week mHealth program delivered via WeChat, a social media app highly popular in Chinese Americans. By subscribing to the official WECARE account, users can receive 6 interactive multimedia articles pushed to their WeChat accounts each week for 7 weeks. The 7 major themes include (1) facts of dementia and caregiving; (2) the enhancement of caregiving skills; (3) effective communication with health care providers, care partners, and family members; (4) problem-solving skills for caregiving stress management; (5) stress reduction and depression prevention; (6) the practice of self-care and health behaviors; and (7) social support and available resources. Users also have the option of joining group chats for peer support. The WECARE program also includes a back-end database that manages intervention delivery and tracks user engagement. Conclusions: The WECARE program represents one of the first culturally tailored social media–based interventions for Chinese American caregivers of persons with dementia. It demonstrates the use of community-based user-centered design principles in developing an mHealth intervention program in underserved communities. We call for more cultural adaptation and development of mHealth interventions for immigrant and racial/ethnic minority caregivers of persons with dementia. %M 36173667 %R 10.2196/40171 %U https://aging.jmir.org/2022/3/e40171 %U https://doi.org/10.2196/40171 %U http://www.ncbi.nlm.nih.gov/pubmed/36173667 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e36247 %T Usability and Effectiveness of an Individualized, Tablet-Based, Multidomain Exercise Program for People With Dementia Delivered by Nursing Assistants: Protocol for an Evaluation of the InCoPE-App %A Barisch-Fritz,Bettina %A Bezold,Jelena %A Scharpf,Andrea %A Trautwein,Sandra %A Krell-Roesch,Janina %A Woll,Alexander %+ Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 017623523840, bettina.barisch-fritz@kit.edu %K institutionalization %K institutionalized %K sport %K physical activity %K fitness %K exercise %K dementia %K digital application %K cognitive performance %K physical performance %K cognitive function %K physical function %K cognitive decline %K nursing home %K long-term care %K usability %K effectiveness %K mHealth %K mobile health %K health app %D 2022 %7 26.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic’s impact. Objective: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. Methods: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. Results: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. Conclusions: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. Trial Registration: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069 International Registered Report Identifier (IRRID): DERR1-10.2196/36247 %M 36156463 %R 10.2196/36247 %U https://www.researchprotocols.org/2022/9/e36247 %U https://doi.org/10.2196/36247 %U http://www.ncbi.nlm.nih.gov/pubmed/36156463 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e33460 %T Evaluating Web-Based Automatic Transcription for Alzheimer Speech Data: Transcript Comparison and Machine Learning Analysis %A Soroski,Thomas %A da Cunha Vasco,Thiago %A Newton-Mason,Sally %A Granby,Saffrin %A Lewis,Caitlin %A Harisinghani,Anuj %A Rizzo,Matteo %A Conati,Cristina %A Murray,Gabriel %A Carenini,Giuseppe %A Field,Thalia S %A Jang,Hyeju %+ Department of Computer Science, Faculty of Science, University of British Columbia, 201-2366 Main Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 822 3061, hyejuj@cs.ubc.ca %K Alzheimer disease %K mild cognitive impairment %K speech %K natural language processing %K speech recognition software %K machine learning %K neurodegenerative disease %K transcription software %K memory %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Speech data for medical research can be collected noninvasively and in large volumes. Speech analysis has shown promise in diagnosing neurodegenerative disease. To effectively leverage speech data, transcription is important, as there is valuable information contained in lexical content. Manual transcription, while highly accurate, limits the potential scalability and cost savings associated with language-based screening. Objective: To better understand the use of automatic transcription for classification of neurodegenerative disease, namely, Alzheimer disease (AD), mild cognitive impairment (MCI), or subjective memory complaints (SMC) versus healthy controls, we compared automatically generated transcripts against transcripts that went through manual correction. Methods: We recruited individuals from a memory clinic (“patients”) with a diagnosis of mild-to-moderate AD, (n=44, 30%), MCI (n=20, 13%), SMC (n=8, 5%), as well as healthy controls (n=77, 52%) living in the community. Participants were asked to describe a standardized picture, read a paragraph, and recall a pleasant life experience. We compared transcripts generated using Google speech-to-text software to manually verified transcripts by examining transcription confidence scores, transcription error rates, and machine learning classification accuracy. For the classification tasks, logistic regression, Gaussian naive Bayes, and random forests were used. Results: The transcription software showed higher confidence scores (P<.001) and lower error rates (P>.05) for speech from healthy controls compared with patients. Classification models using human-verified transcripts significantly (P<.001) outperformed automatically generated transcript models for both spontaneous speech tasks. This comparison showed no difference in the reading task. Manually adding pauses to transcripts had no impact on classification performance. However, manually correcting both spontaneous speech tasks led to significantly higher performances in the machine learning models. Conclusions: We found that automatically transcribed speech data could be used to distinguish patients with a diagnosis of AD, MCI, or SMC from controls. We recommend a human verification step to improve the performance of automatic transcripts, especially for spontaneous tasks. Moreover, human verification can focus on correcting errors and adding punctuation to transcripts. However, manual addition of pauses is not needed, which can simplify the human verification step to more efficiently process large volumes of speech data. %M 36129754 %R 10.2196/33460 %U https://aging.jmir.org/2022/3/e33460 %U https://doi.org/10.2196/33460 %U http://www.ncbi.nlm.nih.gov/pubmed/36129754 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38211 %T An Unsupervised Data-Driven Anomaly Detection Approach for Adverse Health Conditions in People Living With Dementia: Cohort Study %A Bijlani,Nivedita %A Nilforooshan,Ramin %A Kouchaki,Samaneh %+ Centre for Vision, Speech and Signal Processing, University of Surrey, 388 Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 1483 300 800, n.bijlani@surrey.ac.uk %K contextual matrix profile %K multidimensional anomaly detection %K outlier detection %K sensor-based remote health monitoring %K dementia %K unsupervised learning %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Sensor-based remote health monitoring can be used for the timely detection of health deterioration in people living with dementia with minimal impact on their day-to-day living. Anomaly detection approaches have been widely applied in various domains, including remote health monitoring. However, current approaches are challenged by noisy, multivariate data and low generalizability. Objective: This study aims to develop an online, lightweight unsupervised learning–based approach to detect anomalies representing adverse health conditions using activity changes in people living with dementia. We demonstrated its effectiveness over state-of-the-art methods on a real-world data set of 9363 days collected from 15 participant households by the UK Dementia Research Institute between August 2019 and July 2021. Our approach was applied to household movement data to detect urinary tract infections (UTIs) and hospitalizations. Methods: We propose and evaluate a solution based on Contextual Matrix Profile (CMP), an exact, ultrafast distance-based anomaly detection algorithm. Using daily aggregated household movement data collected via passive infrared sensors, we generated CMPs for location-wise sensor counts, duration, and change in hourly movement patterns for each patient. We computed a normalized anomaly score in 2 ways: by combining univariate CMPs and by developing a multidimensional CMP. The performance of our method was evaluated relative to Angle-Based Outlier Detection, Copula-Based Outlier Detection, and Lightweight Online Detector of Anomalies. We used the multidimensional CMP to discover and present the important features associated with adverse health conditions in people living with dementia. Results: The multidimensional CMP yielded, on average, 84.3% recall with 32.1 alerts, or a 5.1% alert rate, offering the best balance of recall and relative precision compared with Copula-Based and Angle-Based Outlier Detection and Lightweight Online Detector of Anomalies when evaluated for UTI and hospitalization. Midnight to 6 AM bathroom activity was shown to be the most important cross-patient digital biomarker of anomalies indicative of UTI, contributing approximately 30% to the anomaly score. We also demonstrated how CMP-based anomaly scoring can be used for a cross-patient view of anomaly patterns. Conclusions: To the best of our knowledge, this is the first real-world study to adapt the CMP to continuous anomaly detection in a health care scenario. The CMP inherits the speed, accuracy, and simplicity of the Matrix Profile, providing configurability, the ability to denoise and detect patterns, and explainability to clinical practitioners. We addressed the need for anomaly scoring in multivariate time series health care data by developing the multidimensional CMP. With high sensitivity, a low alert rate, better overall performance than state-of-the-art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique extensible to multimodal data for dementia and other health care scenarios. %M 36121687 %R 10.2196/38211 %U https://aging.jmir.org/2022/3/e38211 %U https://doi.org/10.2196/38211 %U http://www.ncbi.nlm.nih.gov/pubmed/36121687 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39547 %T Automatically Identifying Twitter Users for Interventions to Support Dementia Family Caregivers: Annotated Data Set and Benchmark Classification Models %A Klein,Ari Z %A Magge,Arjun %A O'Connor,Karen %A Gonzalez-Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Fl., 423 Guardian Dr., Philadelphia, PA, 19104, United States, 1 310 423 3521, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K data mining %K dementia %K Alzheimer disease %K caregivers %D 2022 %7 16.9.2022 %9 Short Paper %J JMIR Aging %G English %X Background: More than 6 million people in the United States have Alzheimer disease and related dementias, receiving help from more than 11 million family or other informal caregivers. A range of traditional interventions has been developed to support family caregivers; however, most of them have not been implemented in practice and remain largely inaccessible. While recent studies have shown that family caregivers of people with dementia use Twitter to discuss their experiences, methods have not been developed to enable the use of Twitter for interventions. Objective: The objective of this study is to develop an annotated data set and benchmark classification models for automatically identifying a cohort of Twitter users who have a family member with dementia. Methods: Between May 4 and May 20, 2021, we collected 10,733 tweets, posted by 8846 users, that mention a dementia-related keyword, a linguistic marker that potentially indicates a diagnosis, and a select familial relationship. Three annotators annotated 1 random tweet per user to distinguish those that indicate having a family member with dementia from those that do not. Interannotator agreement was 0.82 (Fleiss kappa). We used the annotated tweets to train and evaluate support vector machine and deep neural network classifiers. To assess the scalability of our approach, we then deployed automatic classification on unlabeled tweets that were continuously collected between May 4, 2021, and March 9, 2022. Results: A deep neural network classifier based on a BERT (bidirectional encoder representations from transformers) model pretrained on tweets achieved the highest F1-score of 0.962 (precision=0.946 and recall=0.979) for the class of tweets indicating that the user has a family member with dementia. The classifier detected 128,838 tweets that indicate having a family member with dementia, posted by 74,290 users between May 4, 2021, and March 9, 2022—that is, approximately 7500 users per month. Conclusions: Our annotated data set can be used to automatically identify Twitter users who have a family member with dementia, enabling the use of Twitter on a large scale to not only explore family caregivers’ experiences but also directly target interventions at these users. %M 36112408 %R 10.2196/39547 %U https://aging.jmir.org/2022/3/e39547 %U https://doi.org/10.2196/39547 %U http://www.ncbi.nlm.nih.gov/pubmed/36112408 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34450 %T Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial %A Marin,Anna %A DeCaro,Renée %A Schiloski,Kylie %A Elshaar,Ala’a %A Dwyer,Brigid %A Vives-Rodriguez,Ana %A Palumbo,Rocco %A Turk,Katherine %A Budson,Andrew %+ Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130-4817, United States, 1 8573646184, amarin@bu.edu %K cognitive training %K Alzheimer disease dementia %K technology %D 2022 %7 12.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear. Objective: We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period. Methods: Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to AD or mild AD dementia. Participants were randomly assigned to either the Constant Therapy (n=10) or active control (n=9) group. The Constant Therapy group completed a tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The active control group completed paper-and-pencil games during the first 24 weeks and were invited to complete an optional Constant Therapy training during the second 24 weeks. Every 6 weeks, the participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The participants independently accessed Constant Therapy using an Apple iPad. Our primary feasibility outcomes were the rate of adherence and daily use of Constant Therapy over 24 weeks. Our secondary outcomes were Constant Therapy performance over 24 weeks and change in RBANS scores between the 2 experimental groups. Results: Feasibility analyses were computed for participants who completed 24 weeks of Constant Therapy. We found that long-term use of the Constant Therapy program was feasible in patients with AD over 24 weeks (adherence 80%; program use 121/168 days, for 32 minutes daily). These participants showed an overall improvement in accuracy and latency (P=.005) in the Constant Therapy scores, as well as specific improvements in visual and auditory memory, attention, and arithmetic tasks. The Constant Therapy group showed improvement in the RBANS coding subtest. No unexpected problems or adverse events were observed. Conclusions: Long-term (eg, 24 weeks) computerized cognitive training using Constant Therapy is feasible in patients with AD in the mild cognitive impairment and mild dementia stages. Patients adhered more to Constant Therapy than to the paper-and-pencil training over 24 weeks and improved their performance over time. These findings support the development of future randomized controlled trials that will investigate the efficacy of Constant Therapy to sustain cognitive function in patients with AD. Trial Registration: ClinicalTrials.gov NCT02521558; https://clinicaltrials.gov/ct2/show/NCT02521558 %M 36094804 %R 10.2196/34450 %U https://formative.jmir.org/2022/9/e34450 %U https://doi.org/10.2196/34450 %U http://www.ncbi.nlm.nih.gov/pubmed/36094804 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36754 %T The Effectiveness of Serious Games on Cognitive Processing Speed Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Ahmed,Arfan %A Alali,Haitham %A Aldardour,Ahmad Mohammad %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, 0000, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K cognitive training %K exergames %K processing speed %K mild cognitive impairment %K Alzheimer disease %K dementia %K systematic reviews %K meta-analysis %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Serious Games %G English %X Background: Human cognitive processing speed is known to decline with age. Human cognitive processing speed refers to the time that an individual takes from receiving a stimulus to reacting to it. Serious games, which are video games used for training and educational purposes, have the potential to improve processing speed. Numerous systematic reviews have summarized the evidence regarding the effectiveness of serious games in improving processing speed, but they are undermined by some limitations. Objective: This study aimed to examine the effectiveness of serious games on the cognitive processing speed of an older adult population living with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. Two search sources were used in this review: 8 electronic databases and backward and forward reference list checking. A total of 2 reviewers independently checked the eligibility of the studies, extracted data from the included studies, and appraised the risk of bias and quality of the evidence. Evidence from the included studies was synthesized using a narrative and statistical approach (ie, meta-analysis), as appropriate. Results: Of the 548 publications identified, 16 (2.9%) RCTs eventually met all eligibility criteria. Very-low-quality evidence from 50% (8/16) and 38% (6/16) of the RCTs showed no statistically significant effect of serious games on processing speed compared with no or passive intervention groups (P=.77) and conventional exercises (P=.58), respectively. A subgroup analysis showed that both types of serious games (cognitive training games: P=.26; exergames: P=.88) were as effective as conventional exercises in improving processing speed. Conclusions: There is no superiority of serious games over no or passive interventions and conventional exercises in improving processing speed among older adults with cognitive impairment. However, our findings remain inconclusive because of the low quality of the evidence, the small sample size in most of the included studies, and the paucity of studies included in the meta-analyses. Therefore, until more robust evidence is published, serious games should be offered or used as an adjunct to existing interventions. Further trials should be undertaken to investigate the effect of serious games that specifically target processing speed rather than cognitive abilities in general. Trial Registration: PROSPERO CRD42022301667; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301667 %M 36083623 %R 10.2196/36754 %U https://games.jmir.org/2022/3/e36754 %U https://doi.org/10.2196/36754 %U http://www.ncbi.nlm.nih.gov/pubmed/36083623 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38130 %T Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools %A Hackett,Katherine %A Giovannetti,Tania %+ Department of Psychology and Neuroscience, Temple University, 1701 N 13th Street, Weiss Hall 6th Floor, Philadelphia, PA, 19122, United States, 1 215 204 4296, tania.giovannetti@temple.edu %K digital phenotyping %K neuropsychology %K aging %K dementia %K smartphone %K neurological %K psychological %K older adults %K aging %D 2022 %7 7.9.2022 %9 Viewpoint %J JMIR Aging %G English %X As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach—digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults. %M 36069747 %R 10.2196/38130 %U https://aging.jmir.org/2022/3/e38130 %U https://doi.org/10.2196/38130 %U http://www.ncbi.nlm.nih.gov/pubmed/36069747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39805 %T Public Discourse and Sentiment Toward Dementia on Chinese Social Media: Machine Learning Analysis of Weibo Posts %A Kong,Dexia %A Chen,Anfan %A Zhang,Jingwen %A Xiang,Xiaoling %A Lou,W Q Vivian %A Kwok,Timothy %A Wu,Bei %+ School of Journalism and Communication, The Chinese University of Hong Kong, NAH313B, Humanities Building, New Asia College, Hong Kong, 999077, Hong Kong, 852 68436916, anfanchen@cuhk.edu.hk %K dementia %K public discourse %K sentiment %K Weibo %K social media %K machine learning %K infodemiology %K aging %K elderly population %K content analysis %K topic modeling %K thematic analysis %K social support %K sentiment analysis %K public discourse %D 2022 %7 2.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia is a global public health priority due to rapid growth of the aging population. As China has the world’s largest population with dementia, this debilitating disease has created tremendous challenges for older adults, family caregivers, and health care systems on the mainland nationwide. However, public awareness and knowledge of the disease remain limited in Chinese society. Objective: This study examines online public discourse and sentiment toward dementia among the Chinese public on a leading Chinese social media platform Weibo. Specifically, this study aims to (1) assess and examine public discourse and sentiment toward dementia among the Chinese public, (2) determine the extent to which dementia-related discourse and sentiment vary among different user groups (ie, government, journalists/news media, scientists/experts, and the general public), and (3) characterize temporal trends in public discourse and sentiment toward dementia among different user groups in China over the past decade. Methods: In total, 983,039 original dementia-related posts published by 347,599 unique users between 2010 and 2021, together with their user information, were analyzed. Machine learning analytical techniques, including topic modeling, sentiment analysis, and semantic network analyses, were used to identify salient themes/topics and their variations across different user groups (ie, government, journalists/news media, scientists/experts, and the general public). Results: Topic modeling results revealed that symptoms, prevention, and social support are the most prevalent dementia-related themes on Weibo. Posts about dementia policy/advocacy have been increasing in volume since 2018. Raising awareness is the least discussed topic over time. Sentiment analysis indicated that Weibo users generally attach negative attitudes/emotions to dementia, with the general public holding a more negative attitude than other user groups. Conclusions: Overall, dementia has received greater public attention on social media since 2018. In particular, discussions related to dementia advocacy and policy are gaining momentum in China. However, disparaging language is still used to describe dementia in China; therefore, a nationwide initiative is needed to alter the public discourse on dementia. The results contribute to previous research by providing a macrolevel understanding of the Chinese public’s discourse and attitudes toward dementia, which is essential for building national education and policy initiatives to create a dementia-friendly society. Our findings indicate that dementia is associated with negative sentiments, and symptoms and prevention dominate public discourse. The development of strategies to address unfavorable perceptions of dementia requires policy and public health attention. The results further reveal that an urgent need exists to increase public knowledge about dementia. Social media platforms potentially could be leveraged for future dementia education interventions to increase dementia awareness and promote positive attitudes. %M 36053565 %R 10.2196/39805 %U https://www.jmir.org/2022/9/e39805 %U https://doi.org/10.2196/39805 %U http://www.ncbi.nlm.nih.gov/pubmed/36053565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40384 %T Development and Evaluation of a Natural Language Processing Annotation Tool to Facilitate Phenotyping of Cognitive Status in Electronic Health Records: Diagnostic Study %A Noori,Ayush %A Magdamo,Colin %A Liu,Xiao %A Tyagi,Tanish %A Li,Zhaozhi %A Kondepudi,Akhil %A Alabsi,Haitham %A Rudmann,Emily %A Wilcox,Douglas %A Brenner,Laura %A Robbins,Gregory K %A Moura,Lidia %A Zafar,Sahar %A Benson,Nicole M %A Hsu,John %A R Dickson,John %A Serrano-Pozo,Alberto %A Hyman,Bradley T %A Blacker,Deborah %A Westover,M Brandon %A Mukerji,Shibani S %A Das,Sudeshna %+ Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 617 726 2000, SDAS5@mgh.harvard.edu %K chart review %K cognition %K cognitive status %K dementia %K diagnostic %K electronic health record %K health care %K natural language processing %K research cohort %D 2022 %7 30.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health records (EHRs) with large sample sizes and rich information offer great potential for dementia research, but current methods of phenotyping cognitive status are not scalable. Objective: The aim of this study was to evaluate whether natural language processing (NLP)–powered semiautomated annotation can improve the speed and interrater reliability of chart reviews for phenotyping cognitive status. Methods: In this diagnostic study, we developed and evaluated a semiautomated NLP-powered annotation tool (NAT) to facilitate phenotyping of cognitive status. Clinical experts adjudicated the cognitive status of 627 patients at Mass General Brigham (MGB) health care, using NAT or traditional chart reviews. Patient charts contained EHR data from two data sets: (1) records from January 1, 2017, to December 31, 2018, for 100 Medicare beneficiaries from the MGB Accountable Care Organization and (2) records from 2 years prior to COVID-19 diagnosis to the date of COVID-19 diagnosis for 527 MGB patients. All EHR data from the relevant period were extracted; diagnosis codes, medications, and laboratory test values were processed and summarized; clinical notes were processed through an NLP pipeline; and a web tool was developed to present an integrated view of all data. Cognitive status was rated as cognitively normal, cognitively impaired, or undetermined. Assessment time and interrater agreement of NAT compared to manual chart reviews for cognitive status phenotyping was evaluated. Results: NAT adjudication provided higher interrater agreement (Cohen κ=0.89 vs κ=0.80) and significant speed up (time difference mean 1.4, SD 1.3 minutes; P<.001; ratio median 2.2, min-max 0.4-20) over manual chart reviews. There was moderate agreement with manual chart reviews (Cohen κ=0.67). In the cases that exhibited disagreement with manual chart reviews, NAT adjudication was able to produce assessments that had broader clinical consensus due to its integrated view of highlighted relevant information and semiautomated NLP features. Conclusions: NAT adjudication improves the speed and interrater reliability for phenotyping cognitive status compared to manual chart reviews. This study underscores the potential of an NLP-based clinically adjudicated method to build large-scale dementia research cohorts from EHRs. %M 36040790 %R 10.2196/40384 %U https://www.jmir.org/2022/8/e40384 %U https://doi.org/10.2196/40384 %U http://www.ncbi.nlm.nih.gov/pubmed/36040790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e35072 %T The Human Need for Equilibrium: Qualitative Study on the Ingenuity, Technical Competency, and Changing Strategies of People With Dementia Seeking Health Information %A Dixon,Emma %A Anderson,Jesse %A Blackwelder,Diana C %A Radnofsky,Mary L %A Lazar,Amanda %+ College of Information Studies, University of Maryland, 4130 Campus Dr 4th floor, College Park, MD, 20742, United States, 1 843 609 7249, eedixon@umd.edu %K dementia %K health information behavior %K action research %K equilibrium %K postdiagnostic experience %K mobile phone %D 2022 %7 11.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior research on health information behaviors of people with dementia has primarily focused on examining the types of information exchanged by people with dementia using various web-based platforms. A previous study investigated the information behaviors of people with dementia within a month of their diagnosis. There is an empirical gap in the literature regarding the evolution of health information needs and behaviors of people with dementia as their condition progresses. Objective: Our work primarily investigated the information behaviors of people with dementia who have been living with the condition for several (4 to 26) years. We also aimed to identify their motivations for changing their information behaviors over time. Our primary research questions were as follows: how do people with dementia get informed about their condition, and why do people with dementia seek information about their condition? Methods: We adopted an action research approach by including 2 people with dementia as members of our research team. Collaboratively, we conducted 16 remote 1-hour contextual inquiry sessions with people living with mild to moderate dementia. During the study sessions, the first 40 minutes included semistructured interviews with participants concerning their information behaviors, followed by a 20-minute demonstration of their information-seeking strategies. Data from these interviews were analyzed using a constructivist grounded theory approach. Results: Participants described their information needs in terms of managing the disrupted physiological, emotional, and social aspects of their lives following a diagnosis of dementia. They used various information behaviors, including active search, ongoing search, monitoring, proxy search, information avoidance, and selective exposure. These information behaviors were not stagnant; however, they were adapted to accommodate the changing circumstances of their dementia and their lives as they worked to re-establish equilibrium to continue to engage in life while living with a degenerative neurological condition. Conclusions: Our research revealed the motivations, changing abilities, and chosen strategies of people with dementia in their search for information as their condition evolves. This knowledge can be used to develop and improve person-centered information and support services for people with dementia so that they can more easily re-establish equilibrium and continue to engage in life. %M 35969426 %R 10.2196/35072 %U https://www.jmir.org/2022/8/e35072 %U https://doi.org/10.2196/35072 %U http://www.ncbi.nlm.nih.gov/pubmed/35969426 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35442 %T Description of the Method for Evaluating Digital Endpoints in Alzheimer Disease Study: Protocol for an Exploratory, Cross-sectional Study %A Curcic,Jelena %A Vallejo,Vanessa %A Sorinas,Jennifer %A Sverdlov,Oleksandr %A Praestgaard,Jens %A Piksa,Mateusz %A Deurinck,Mark %A Erdemli,Gul %A Bügler,Maximilian %A Tarnanas,Ioannis %A Taptiklis,Nick %A Cormack,Francesca %A Anker,Rebekka %A Massé,Fabien %A Souillard-Mandar,William %A Intrator,Nathan %A Molcho,Lior %A Madero,Erica %A Bott,Nicholas %A Chambers,Mieko %A Tamory,Josef %A Shulz,Matias %A Fernandez,Gerardo %A Simpson,William %A Robin,Jessica %A Snædal,Jón G %A Cha,Jang-Ho %A Hannesdottir,Kristin %+ Novartis Institutes for Biomedical Research, Fabrikstrasse 2 Novartis Campus, Basel, 4056, Switzerland, 41 795003648, jelena.curcic@novartis.com %K digital endpoints %K cognition %K Alzheimer disease %K brain amyloid %K methodology study %K clinical trial design %K mobile phone %D 2022 %7 10.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: More sensitive and less burdensome efficacy end points are urgently needed to improve the effectiveness of clinical drug development for Alzheimer disease (AD). Although conventional end points lack sensitivity, digital technologies hold promise for amplifying the detection of treatment signals and capturing cognitive anomalies at earlier disease stages. Using digital technologies and combining several test modalities allow for the collection of richer information about cognitive and functional status, which is not ascertainable via conventional paper-and-pencil tests. Objective: This study aimed to assess the psychometric properties, operational feasibility, and patient acceptance of 10 promising technologies that are to be used as efficacy end points to measure cognition in future clinical drug trials. Methods: The Method for Evaluating Digital Endpoints in Alzheimer Disease study is an exploratory, cross-sectional, noninterventional study that will evaluate 10 digital technologies’ ability to accurately classify participants into 4 cohorts according to the severity of cognitive impairment and dementia. Moreover, this study will assess the psychometric properties of each of the tested digital technologies, including the acceptable range to assess ceiling and floor effects, concurrent validity to correlate digital outcome measures to traditional paper-and-pencil tests in AD, reliability to compare test and retest, and responsiveness to evaluate the sensitivity to change in a mild cognitive challenge model. This study included 50 eligible male and female participants (aged between 60 and 80 years), of whom 13 (26%) were amyloid-negative, cognitively healthy participants (controls); 12 (24%) were amyloid-positive, cognitively healthy participants (presymptomatic); 13 (26%) had mild cognitive impairment (predementia); and 12 (24%) had mild AD (mild dementia). This study involved 4 in-clinic visits. During the initial visit, all participants completed all conventional paper-and-pencil assessments. During the following 3 visits, the participants underwent a series of novel digital assessments. Results: Participant recruitment and data collection began in June 2020 and continued until June 2021. Hence, the data collection occurred during the COVID-19 pandemic (SARS-CoV-2 virus pandemic). Data were successfully collected from all digital technologies to evaluate statistical and operational performance and patient acceptance. This paper reports the baseline demographics and characteristics of the population studied as well as the study's progress during the pandemic. Conclusions: This study was designed to generate feasibility insights and validation data to help advance novel digital technologies in clinical drug development. The learnings from this study will help guide future methods for assessing novel digital technologies and inform clinical drug trials in early AD, aiming to enhance clinical end point strategies with digital technologies. International Registered Report Identifier (IRRID): DERR1-10.2196/35442 %M 35947423 %R 10.2196/35442 %U https://www.researchprotocols.org/2022/8/e35442 %U https://doi.org/10.2196/35442 %U http://www.ncbi.nlm.nih.gov/pubmed/35947423 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e35202 %T The Effectiveness of Serious Games in Improving Memory Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Alhuwail,Dari %A Al-Jafar,Eiman %A Ahmed,Arfan %A Shuweihdi,Farag %A Reagu,Shuja Mohd %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K cognitive training %K exergames %K mild cognitive impairment %K Alzheimer disease %K dementia %K memory %K systematic reviews %K meta-analysis %K mobile phone %D 2022 %7 9.8.2022 %9 Review %J JMIR Serious Games %G English %X Background: Memory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated. Objective: This study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment. Methods: A systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate. Results: Of the 618 citations retrieved, 18 (2.9%) met the eligibility criteria for this review. Of these 18 studies, 15 (83%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95% CI −0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=−0.19, 95% CI −0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95% CI −0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95% CI −0.21 to 1.54), nonverbal memory (P=.94; SMD=−0.01, 95% CI −0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95% CI −0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95% CI −0.02 to 0.37). Conclusions: Serious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment. %M 35943792 %R 10.2196/35202 %U https://games.jmir.org/2022/3/e35202 %U https://doi.org/10.2196/35202 %U http://www.ncbi.nlm.nih.gov/pubmed/35943792 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36975 %T A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study %A Boutilier,Justin J %A Loganathar,Priya %A Linden,Anna %A Scheer,Eleanore %A Noejovich,Sofia %A Elliott,Christian %A Zuraw,Matthew %A Werner,Nicole E %+ Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, 1025 E 7th St, Bloomington, IN, 47405, United States, 1 703 340 7177, newerner@iu.edu %K Alzheimer disease and related dementias %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue’s feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75%), White (44/51, 86%), married (37/51, 73%), college educated (36/51, 71%), and were, on average, 60.3 (SD 9.8) years of age, with 18% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating “good” usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US $100K and mean 55.4 for those reporting 90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. Conclusions: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits. %M 35896014 %R 10.2196/39335 %U https://aging.jmir.org/2022/3/e39335 %U https://doi.org/10.2196/39335 %U http://www.ncbi.nlm.nih.gov/pubmed/35896014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e33881 %T A Self-management App for People Living With Mild Dementia (PRIDE): Protocol for a Pre-Post Feasibility Study %A Lee,Abigail Rebecca %A McDermott,Orii %A Guo,Boliang %A Roe,James %A Orrell,Martin %+ Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, Institute of Mental Health, University of Nottingham - Jubilee Campus, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07890021703, abigail.lee1@nottingham.ac.uk %K dementia %K protocol %K self-management %K quality of life %K web-based %K psychology %K social %K intervention %K app %D 2022 %7 27.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the rapid increase in the prevalence of dementia in the United Kingdom and beyond, the emotional, social, and economic burden on individuals, families, and health care services continues to rise. Currently, interventions that enable people living with dementia to better manage their condition and achieve a good quality of life are needed. Objective: This study aimed to explore how the Promoting Independence in Dementia (PRIDE) app can promote and support the self-management of people living with mild dementia. Methods: Feasibility of a pre-post study design incorporating the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be studied. We will use up to 6 National Health Service Trusts as research sites and the Join Dementia Research website and accept self-referrals to recruit 60 to 90 people living with mild dementia. Participants will complete the PRIDE app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life will be collected at baseline and at follow-ups at 3 and 6 months. Facilitators and National Health Service staff will be invited to complete interviews shortly after the intervention phase. Results: Data collection began in June 2021 and is predicted to cease by the end of August 2022. Analysis of the quantitative measures will explore the impact of the PRIDE app on participants’ independence, mood, and quality of life. Interview data will discuss participant experiences, how the use of the app affected them, and if it has the potential to be successfully implemented and maintained in dementia services. Conclusions: This study will show the potential reach, effectiveness, and adoption of the PRIDE app intervention in the lives of people with mild dementia. The findings from this study will inform future research on the PRIDE app and any further developments to improve its effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/33881 %M 35896033 %R 10.2196/33881 %U https://www.researchprotocols.org/2022/7/e33881 %U https://doi.org/10.2196/33881 %U http://www.ncbi.nlm.nih.gov/pubmed/35896033 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36720 %T The Long-term Effects of Immersive Virtual Reality Reminiscence in People With Dementia: Longitudinal Observational Study %A Huang,Ling-Chun %A Yang,Yuan-Han %+ Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, 68 Jhonghua 3rd Road, Cianjin District, Kaohsiung, 80145, Taiwan, 886 7 2911101 ext 8913, endlessyhy@gmail.com %K virtual reality %K reminiscence %K dementia %K long-term care %D 2022 %7 25.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Novel nonpharmacological therapies are being developed to prevent cognitive decline and reduce behavioral and psychological symptoms in patients with dementia. Virtual reality (VR) reminiscence was reported to improve anxiety, apathy, and cognitive function immediately after intervention in individuals at residential aged care facilities. However, its effect on elderly patients with dementia and how long this effect could last remain unknown. Objective: The aim of this paper is to investigate the effect of immersive VR reminiscence in people with dementia both immediately after and 3-6 months after intervention. Methods: A pilot study was conducted in 2 dementia care units. VR reminiscence therapy sessions were conducted twice per week for a 3-month period. Cognitive function, global status, depressive symptoms, and caregiver burden were assessed before and immediately after VR intervention in 20 participants. Subsequently, 7 participants were reassessed 3-6 months after the VR intervention. Wilcoxon sign-rank test was used for statistical comparisons of the changes. Results: There were no significant changes in cognitive function, global status, and caregiver burden immediately after the VR intervention, but there was a significant reduction in depressive symptoms (P=.008). Moreover, compared with the cognitive function immediately after VR, it kept declining 3-6 months after. Conclusions: Immersive VR reminiscence can improve mood and preserve cognitive function in elderly patients with dementia during the period of the intervention. Studies using a control group and comparing the use of VR with traditional forms of reminiscence should be conducted in the future to confirm and expand on these findings. %M 35877169 %R 10.2196/36720 %U https://games.jmir.org/2022/3/e36720 %U https://doi.org/10.2196/36720 %U http://www.ncbi.nlm.nih.gov/pubmed/35877169 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36123 %T Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Alhuwail,Dari %A Ahmed,Arfan %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708546, mhouseh@hbku.edu.qa %K serious games %K cognitive training %K exergames %K executive functions %K mild cognitive impairment %K Alzheimer disease %K dementia %K systematic reviews %K meta-analysis %D 2022 %7 25.7.2022 %9 Review %J JMIR Serious Games %G English %X Background: Executive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses. Objective: This study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies. Results: Of 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59). Conclusions: Serious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment. Trial Registration: PROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757 %M 35877166 %R 10.2196/36123 %U https://games.jmir.org/2022/3/e36123 %U https://doi.org/10.2196/36123 %U http://www.ncbi.nlm.nih.gov/pubmed/35877166 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e35376 %T The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation %A Waddington,Claire %A Harding,Emma %A Brotherhood,Emilie V %A Davies Abbott,Ian %A Barker,Suzanne %A Camic,Paul M %A Ezeofor,Victory %A Gardner,Hannah %A Grillo,Adetola %A Hardy,Chris %A Hoare,Zoe %A McKee-Jackson,Roberta %A Moore,Kirsten %A O’Hara,Trish %A Roberts,Jennifer %A Rossi-Harries,Samuel %A Suarez-Gonzalez,Aida %A Sullivan,Mary Pat %A Edwards,Rhiannon Tudor %A Van Der Byl Williams,Millie %A Walton,Jill %A Willoughby,Alicia %A Windle,Gill %A Winrow,Eira %A Wood,Olivia %A Zimmermann,Nikki %A Crutch,Sebastian J %A Stott,Joshua %+ Dementia Research Centre, Institute of Neurology, University College London, Queen Square, London, WC1N 3AR, United Kingdom, 44 020 3325 082, c.waddington@ucl.ac.uk %K dementia %K Alzheimer disease %K frontotemporal dementia %K posterior cortical atrophy %K Lewy body dementia %K Lewy body disease %K primary progressive aphasia %K young-onset dementia %K early-onset dementia %K atypical dementia %K virtual %K web-based %K videoconference %K videophone %K support group %D 2022 %7 20.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective: We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods: We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results: The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions: The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID): DERR1-10.2196/35376 %M 35857375 %R 10.2196/35376 %U https://www.researchprotocols.org/2022/7/e35376 %U https://doi.org/10.2196/35376 %U http://www.ncbi.nlm.nih.gov/pubmed/35857375 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e38465 %T Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study %A Chang,Chien-Hsiang %A Yeh,Chung-Hsing %A Chang,Chien-Cheng %A Lin,Yang-Cheng %+ Department of Industrial Design, National Cheng Kung University, Number 1, University Road, Tainan City, 701, Taiwan, 886 62757575 ext 54343, lyc0914@mail.ncku.edu.tw %K dementia %K elderly %K usability %K gesture recognition %K card recognition rehabilitation %K interactive somatosensory game %D 2022 %7 14.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: In aging societies, dementia risk increases with advancing age, increasing the incidence of dementia-related degenerative diseases and other complications, especially fall risk. Dementia also escalates the care burden, impacting patients, their families, social welfare institutions, and the social structure and medical system. Objective: In elderly dementia, traditional card recognition rehabilitation (TCRR) does not effectively increase one’s autonomy. Therefore, from the usability perspective, we used the Tetris game as a reference to develop an interactive somatosensory game rehabilitation (ISGR) with nostalgic style for elders with mild cognitive impairment (MCI). Through intuitive gesture-controlled interactive games, we evaluated subjective feelings concerning somatosensory game integration into rehabilitation to explore whether the ISGR could improve the willingness to use and motivation for rehabilitation among elders with MCI. Methods: A total of 15 elders with MCI (7 males and 8 females with an average age of 78.4 years) underwent 2 experiments for 15 minutes. During experiment 1, TCRR was performed, followed by completing the questionnaire of the System Usability Scale (SUS). After 3-5 minutes, the second experiment (the ISGR) was conducted, followed by completing another SUS. We used SUS to explore differences in impacts of TCRR and ISGR on willingness to use among elders with MCI. In addition, we further investigated whether the factor of gender or prior rehabilitation experience would affect the rehabilitation willingness or not. Results: The novel ISGR made the elderly feel interested and improved their willingness for continuous rehabilitation. According to the overall SUS score, the ISGR had better overall usability performance (73.7) than the TCRR (58.0) (t28=–4.62, P<.001). Furthermore, the ISGR individual item scores of “Willingness to Use” (t28=–8.27, P<.001), “Easy to Use” (t28=–3.17, P<.001), “System Integration” (t28=–5.07, P<.001), and “Easy to Learn” (t28=–2.81, P<.001) were better than TCRR. The somatosensory game was easier to learn and master for females than for males (t13=2.71, P=.02). Besides, the ISGR was easier to use (t12=–2.50, P=.02) and learn (t14=–3.33, P<.001) for those without prior rehabilitation experience. The result indicates that for elders with no rehabilitation experience ISGR was easier to use and simpler to learn than TCRR. Conclusions: Regardless of prior rehabilitation experience, the ISGR developed in this study was easy to learn and effective in continuously improving willingness to use. Furthermore, the adoption of a nostalgic game design style served the function of cognitive training and escalated interest in rehabilitation. The ISGR also improved user stickiness by introducing different game scenarios and difficulties, increasing long-term interest and motivation for rehabilitation. For future research on the adoption of interactive somatosensory games in rehabilitation, additional rehabilitation movements can be developed to benefit the elderly with MCI. %M 35834303 %R 10.2196/38465 %U https://games.jmir.org/2022/3/e38465 %U https://doi.org/10.2196/38465 %U http://www.ncbi.nlm.nih.gov/pubmed/35834303 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38595 %T Behavioral Change Factors and Retention in Web-Based Interventions for Informal Caregivers of People Living With Dementia: Scoping Review %A Wu,Kuan-Ching %A Su,Yan %A Chu,Frances %A Chen,Annie T %A Zaslavsky,Oleg %+ School of Nursing, University of Washington, 1959 NE Pacific St,, Seattle, WA, 98195, United States, 1 2065438736, kuancw@uw.edu %K dementia %K informal caregivers %K informal care %K caregiving %K retention %K internet %K web-based %K behavior %K intervention %K review %K scoping %K health intervention %K digital health %K caregiver %K psychological health %K cognition %K peer support %K web-based intervention %K taxonomy %K aging %K gerontology %K older adult population %K neurological disorder %K behavior change technique %K BCT %K change technique %D 2022 %7 7.7.2022 %9 Review %J J Med Internet Res %G English %X Background: Web-based interventions aimed at supporting informal caregivers of people living with dementia have the potential to improve caregivers’ well-being and psychological health. However, few interventions are widely implemented for this population, and none of the prior reviews have systematically examined the use of behavior change techniques (BCTs), theories, and agents in web-based interventions for informal caregivers of people living with dementia. To better understand this implementation gap, we reviewed the literature to map behavioral factors (BCTs, theories, and agents) deployed in the studies. Furthermore, because there is an emerging consensus that retention could be shaped by participant characteristics and behavioral factors, we explored relationships between these features and retention rates across studies. Objective: We pursued 3 objectives: to map behavioral factors involved in the web-based interventions for informal caregivers of people living with dementia; to examine the relationship between behavioral change elements and retention in the studies; and to examine the relationship between participant characteristics (gender, age, and spouse or adult children caregiver proportion) and study retention. Methods: We conducted a literature review using the following keywords and their corresponding Medical Subject Headings terms: dementia, caregivers, and web-based intervention. The time limits were January 1998 to March 2022. Using the BCTv1 taxonomy, which specifies active behavioral components in interventions, 2 coders collected, summarized, and analyzed the frequency distributions of BCTs. Similarly, they abstracted and analyzed participant characteristics, behavior change theories, behavior change agents, and retention rates in the studies. Results: The average age was 61.5 (SD 7.4) years, and the average proportion of spousal informal caregivers, adult children informal caregivers, and retention rates were 51.2% (SD 24.8%), 44.8% (SD 22%), and 70.4% (SD 17%), respectively. Only 53% (17/32) of the studies used behavior change theories, but 81% (26/32) included behavior change agents. The most common BCTv1 clusters were shaping knowledge and social support. The median number of BCTv1 clusters was 5 (IQR 3). We observed a negative correlation between the proportion of spousal informal caregivers and the retention rate (r=−0.45; P=.02) and between the number of BCTv1 clusters and retention rates (r=−0.47; P=.01). We also found that the proportion of adult children informal caregivers in the study was significantly and positively correlated with the retention rate (r=0.5; P=.03). No other participant characteristics or behavioral factors were associated with retention rates. Conclusions: We found that almost half of the studies were not informed by behavior change theories. In addition, spousal involvement and a higher number of BCTs were each associated with lower retention rates, while the involvement of adult children caregivers in the study was associated with higher retention. In planning future studies, researchers should consider matching participant characteristics with their intended intervention as the alignment might improve their retention rates. %M 35797100 %R 10.2196/38595 %U https://www.jmir.org/2022/7/e38595 %U https://doi.org/10.2196/38595 %U http://www.ncbi.nlm.nih.gov/pubmed/35797100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38379 %T Development of Best Practice Guidance on Online Peer Support for People With Young Onset Dementia: Protocol for a Mixed Methods Study %A Gerritzen,Esther Vera %A McDermott,Orii %A Orrell,Martin %+ Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1157484262, Esther.Gerritzen@nottingham.ac.uk %K young onset dementia %K peer support %K eHealth %K social health %K mixed methods %D 2022 %7 5.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many people with young onset dementia (YOD) may feel isolated. Peer support has the potential to improve social health, but the inconsistent availability of age-appropriate, in-person (peer) support services for people with YOD suggests that many people with YOD miss out on the potential benefits. Online peer support could be useful, as it overcomes geographical barriers, offers a variety of options, and adjusts to various needs and preferences. Objective: Our study aims to develop evidence-based best practice guidance on online peer support for people with YOD and group facilitators to improve online peer support for people with YOD. Methods: Our mixed methods study consists of 4 phases and follows the guidelines of the Medical Research Council on complex interventions. Each phase consists of multiple substudies. The study focuses on the development stage of the Medical Research Council framework and additionally develops a plan for the feasibility/piloting, evaluation, and implementation stages. The participants are people living with YOD and peer support facilitators. The qualitative research methods include interviews, focus groups, and open questions in a web-based survey. The quantitative methods include a web-based survey consisting of existing outcome measures. Results: The study is funded by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Actions – Innovative Training Networks (H2020-MSCA-ITN-2018; grant agreement number: 813196), and it received ethical approval from the London Bromley Research Ethics Committee (reference number: 21/LO/0248) in April 2021. Recruitment started in May 2021. Data collection and analysis are expected to be finished by September 2022. Conclusions: The best practice guidance can provide people with YOD with tailored and evidence-based information about online peer support, and it will be disseminated locally (in the United Kingdom) and internationally through dementia organizations, research networks, and academic institutions. International Registered Report Identifier (IRRID): DERR1-10.2196/38379 %M 35788470 %R 10.2196/38379 %U https://www.researchprotocols.org/2022/7/e38379 %U https://doi.org/10.2196/38379 %U http://www.ncbi.nlm.nih.gov/pubmed/35788470 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38896 %T The Effect of Cognitive Function Health Care Using Artificial Intelligence Robots for Older Adults: Systematic Review and Meta-analysis %A Lee,Hocheol %A Chung,Min Ah %A Kim,Hyeji %A Nam,Eun Woo %+ Department of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K older adult population %K older adults %K cognition %K cognitive function %K artificial intelligence %K socially assistive robots %K AI SAR %K social prescription %K dementia %K social support %K aging %K caregiver %K caregiving %K meta-analysis %K review %K Cochrane collaboration %K assistive robot %K assistive technology %D 2022 %7 28.6.2022 %9 Review %J JMIR Aging %G English %X Background: With rapidly aging populations in most parts of the world, it is only natural that the need for caregivers for older adults is going to increase in the near future. Therefore, most technologically proficient countries are in the process of using artificial intelligence (AI) to build socially assistive robots (SAR) to play the role of caregivers in enhancing interaction and social participation among older adults. Objective: This study aimed to examine the effect of intervention through AI SAR on the cognitive function of older adults through a systematic literature review. Methods: We conducted a meta-analysis of the various existing studies on the effect of AI SAR on the cognitive function of older adults to standardize the results and clarify the effect of each method and indicator. Cochrane collaboration and the systematic literature review flow of PRISMA (Preferred Reporting Item Systematic Reviews and Meta-Analyses) were used on original, peer-reviewed studies published from January 2010 to March 2022. The search words were derived by combining keywords including Population, Intervention, and Outcome—according to the Population, Intervention, Comparison, Outcome, Time, Setting, and Study Design principle—for the question “What is the effect of AI SAR on the cognitive function of older adults in comparison with a control group?” (Population: adults aged ≥65 years; Intervention: AI SAR; Comparison: comparison group; Outcome: popular function; and Study Design: prospective study). For any study, if one condition among subjects, intervention, comparison, or study design was different from those indicated, the study was excluded from the literature review. Results: In total, 9 studies were selected (6 randomized controlled trials and 3 quasi-experimental design studies) for the meta-analysis. Publication bias was examined using the contour-enhanced funnel plot method to confirm the reliability and validity of the 9 studies. The meta-analysis revealed that the average effect size of AI SAR was shown to be Hedges g=0.43 (95% CI –0.04 to 0.90), indicating that AI SAR are effective in reducing the Mini Mental State Examination scale, which reflects cognitive function. Conclusions: The 9 studies that were analyzed used SAR in the form of animals, robots, and humans. Among them, AI SAR in anthropomorphic form were able to improve cognitive function more effectively. The development and expansion of AI SAR programs to various functions including health notification, play therapy, counseling service, conversation, and dementia prevention programs are expected to improve the quality of care for older adults and prevent the overload of caregivers. AI SAR can be considered a representative, digital, and social prescription program and a nonpharmacological intervention program that communicates with older adults 24 hours a day. Despite its effectiveness, ethical issues, the digital literacy needs of older adults, social awareness and reliability, and technological advancement pose challenges in implementing AI SAR. Future research should include bigger sample sizes, pre-post studies, as well as studies using an older adult control group. %M 35672268 %R 10.2196/38896 %U https://aging.jmir.org/2022/2/e38896 %U https://doi.org/10.2196/38896 %U http://www.ncbi.nlm.nih.gov/pubmed/35672268 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35961 %T Digital Health Apps in the Context of Dementia: Questionnaire Study to Assess the Likelihood of Use Among Physicians %A Schinle,Markus %A Erler,Christina %A Kaliciak,Mayumi %A Milde,Christopher %A Stock,Simon %A Gerdes,Marius %A Stork,Wilhelm %+ Medical Information Technology, Embedded Systems and Sensors Engineering, FZI Research Center for Information Technology, Haid-und-Neu-Str. 10-14, Karlsruhe, 76131, Germany, 49 721 9654 75, schinle@fzi.de %K digital health applications %K likelihood of use %K usability %K adherence %K dementia %K screening %K treatment %K physician %K eHealth %K questionnaire %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Age-related diseases such as dementia are playing an increasingly important role in global population development. Thus, prevention, diagnostics, and interventions require more accessibility, which can be realized through digital health apps. With the app on prescription, Germany made history by being the first country worldwide to offer physicians the possibility to prescribe and reimburse digital health apps as of the end of the year 2020. Objective: Considering the lack of knowledge about correlations with the likelihood of use among physicians, this study aimed to address the question of what makes the use of a digital health app by physicians more likely. Methods: We developed and validated a novel measurement tool—the Digital Health Compliance Questionnaire (DHCQ)—in an interdisciplinary collaboration of experts to assess the role of proposed factors in the likelihood of using a health app. Therefore, a web-based survey was conducted to evaluate the likelihood of using a digital app called DemPredict to screen for Alzheimer dementia. Within this survey, 5 latent dimensions (acceptance, attitude toward technology, technology experience, payment for time of use, and effort of collection), the dependent variable likelihood of use, and answers to exploratory questions were recorded and tested within directed correlations. Following a non–probability-sampling strategy, the study was completed by 331 physicians from Germany in the German language, of whom 301 (90.9%) fulfilled the study criteria (eg, being in regular contact with patients with dementia). These data were analyzed using a range of statistical methods to validate the dimensions of the DHCQ. Results: The DHCQ revealed good test theoretical measures—it showed excellent fit indexes (Tucker-Lewis index=0.98; comparative fit index=0.982; standardized root mean square residual=0.073; root mean square error of approximation=0.037), good internal consistency (Cronbach α=.83), and signs of moderate to large correlations between the DHCQ dimensions and the dependent variable. The correlations between the variables acceptance, attitude toward technology, technology experience, and payment for the time of use and the dependent variable likelihood of use ranged from 0.29 to 0.79, and the correlation between effort of the collection and likelihood of use was −0.80. In addition, we found high levels of skepticism regarding data protection, and the age of the participants was found to be negatively related to their technical experience and attitude toward technology. Conclusions: In the context of the results, increased communication between the medical and technology sectors and significantly more awareness raising are recommended to make the use of digital health apps more attractive to physicians as they can be adjusted to their everyday needs. Further research could explore the connection between areas such as adherence on the patient side and its impact on the likelihood of use by physicians. %M 35731567 %R 10.2196/35961 %U https://formative.jmir.org/2022/6/e35961 %U https://doi.org/10.2196/35961 %U http://www.ncbi.nlm.nih.gov/pubmed/35731567 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e34550 %T Implementing a Personalized Integrated Stepped-Care Method (STIP-Method) to Prevent and Treat Neuropsychiatric Symptoms in Persons With Dementia in Nursing Homes: Protocol for a Mixed Methods Study %A Verstraeten,Helma M F %A Ziylan,Canan %A Gerritsen,Debby L %A Huijsman,Robbert %A Nakanishi,Miharu %A Smalbrugge,Martin %A van der Steen,Jenny T %A Zuidema,Sytse U %A Achterberg,Wilco P %A Bakker,Ton J E M %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands, 31 610081039, w.m.f.verstraeten-de_keuninck@lumc.nl %K dementia %K neuropsychiatric symptoms %K caregiver %K implementation %K psychosocial intervention %K nursing homes %D 2022 %7 22.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) pre- and postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. Results: We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. Conclusions: Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms. International Registered Report Identifier (IRRID): DERR1-10.2196/34550 %M 35731558 %R 10.2196/34550 %U https://www.researchprotocols.org/2022/6/e34550 %U https://doi.org/10.2196/34550 %U http://www.ncbi.nlm.nih.gov/pubmed/35731558 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e32489 %T Perceptions of Cognitive Training Games and Assessment Technologies for Dementia: Acceptability Study With Patient and Public Involvement Workshops %A Harrington,Kyle %A Craven,Michael P %A Wilson,Max L %A Landowska,Aleksandra %+ NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, NG7 2TU, United Kingdom, 44 115 823 1294, kyle.harrington@nottingham.ac.uk %K dementia %K cognitive assessment %K cognitive training %K serious games %K patient and public involvement %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive training and assessment technologies offer the promise of dementia risk reduction and a more timely diagnosis of dementia, respectively. Cognitive training games may help reduce the lifetime risk of dementia by helping to build cognitive reserve, whereas cognitive assessment technologies offer the opportunity for a more convenient approach to early detection or screening. Objective: This study aims to elicit perspectives of potential end users on factors related to the acceptability of cognitive training games and assessment technologies, including their opinions on the meaningfulness of measurement of cognition, barriers to and facilitators of adoption, motivations to use games, and interrelationships with existing health care infrastructure. Methods: Four linked workshops were conducted with the same group, each focusing on a specific topic: meaningful improvement, learning and motivation, trust in digital diagnosis, and barriers to technology adoption. Participants in the workshops included local involvement team members acting as facilitators and those recruited via Join Dementia Research through a purposive selection and volunteer sampling method. Group activities were recorded, and transcripts were analyzed using thematic analysis with a combination of a priori and data-driven themes. Using a mixed methods approach, we investigated the relationships between the categories of the Capability, Opportunity, and Motivation–Behavior change model along with data-driven themes by measuring the φ coefficient between coded excerpts and ensuring the reliability of our coding scheme by using independent reviewers and assessing interrater reliability. Finally, we explored these themes and their relationships to address our research objectives. Results: In addition to discussions around the capability, motivation, and opportunity categories, several important themes emerged during the workshops: family and friends, cognition and mood, work and hobbies, and technology. Group participants mentioned the importance of functional and objective measures of cognitive change, the social aspect of activities as a motivating factor, and the opportunities and potential shortcomings of digital health care provision. Our quantitative results indicated at least moderate agreement on all but one of the coding schemes and good independence of our coding categories. Positive and statistically significant φ coefficients were observed between several coding themes between categories, including a relatively strong positive φ coefficient between capability and cognition (0.468; P<.001). Conclusions: The implications for researchers and technology developers include assessing how cognitive training and screening pathways would integrate into existing health care systems; however, further work needs to be undertaken to address barriers to adoption and the potential real-world impact of cognitive training and screening technologies. International Registered Report Identifier (IRRID): RR2-10.1007/978-3-030-49065-2_4 %M 35723912 %R 10.2196/32489 %U https://games.jmir.org/2022/2/e32489 %U https://doi.org/10.2196/32489 %U http://www.ncbi.nlm.nih.gov/pubmed/35723912 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32603 %T Emotional Word Use in Informal Carers of People Living With Dementia: Linguistic Analysis of Online Discussion Forums %A Donnellan,Warren James %A Warren,Jasmine Grace %+ Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, United Kingdom, 44 795 0647 ext 0151, wjd@liverpool.ac.uk %K dementia care %K online forum %K emotional language %K emotional states %K dementia %K aging %K elderly population %K digital health %K online health %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Informal dementia care is uniquely stressful and necessitates effective methods of identifying and understanding the needs of potentially at-risk carers so that they can be supported and sustained in their roles. One such method is examining carers’ engagement in online support platforms. Research has explored emotional word use on online discussion forums as a proxy for underlying emotional functioning. We are not aware of any research that has analyzed the content of posts on discussion forums specific to carers of people living with dementia in order to examine their emotional states. Objective: We addressed the following research questions: (1) To what extent does emotional language use differ between carers of people living with dementia and noncarers? (2) To what extent does emotional language use differ between spousal and parental carers? (3) To what extent does emotional language use differ between current and former carers? Methods: We used the Linguistic Inquiry and Word Count (LIWC) program to examine emotional word use on a UK-based online forum for informal carers of people living with dementia and a discussion forum control group. Carers were separated into different subgroups for the analysis: current and former, and spousal and parental. Results: We found that carers of people living with dementia used significantly more negative, but not positive, emotion words than noncarers. Spousal carers used more emotion words overall than parental carers, specifically more negative emotion words. Former carers used more emotional words overall than current carers, specifically more positive words. Conclusions: The findings suggest that informal carers of people living with dementia may be at increased risk of negative emotional states relative to noncarers. Greater negativity in spousal carers may be explained by increased caregiver burden, whereas greater positivity in former carers may be explained by functional relief of caregiving responsibilities. The theoretical/applied relevance of these findings is discussed. %M 35713942 %R 10.2196/32603 %U https://aging.jmir.org/2022/2/e32603 %U https://doi.org/10.2196/32603 %U http://www.ncbi.nlm.nih.gov/pubmed/35713942 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e37874 %T Impact of Web-Based Cognitive Behavioral Therapy for Insomnia on Stress, Health, Mood, Cognitive, Inflammatory, and Neurodegenerative Outcomes in Rural Dementia Caregivers: Protocol for the NiteCAPP CARES and NiteCAPP SHARES Randomized Controlled Trial %A McCrae,Christina S %A Curtis,Ashley F %A Cottle,Amelia %A Beversdorf,David B %A Shenker,Joel %A Mooney,Brian P %A Popescu,Mihail %A Rantz,Marilyn %A Groer,Maureen %A Stein,Phyllis %A Golzy,Mojgan %A Stearns,Melanie A %A Simenson,Angelynn %A Nair,Neetu %A Rowe,Meredeth A %+ University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, United States, 1 573 882 0982, mccraec@health.missouri.edu %K caregiver %K CBT-I %K cognition %K dementia %K inflammation %K insomnia %K neurodegeneration %D 2022 %7 14.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests that chronic insomnia prompts changes in central stress processing that have downstream negative effects on health and mood, as well as on cognitive, inflammatory, and neurodegenerative functioning. We hypothesize that cognitive behavioral therapy for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing. Rural caregivers are particularly vulnerable, but they have limited access to CBT-I; therefore, we developed an accessible digital version using community input (NiteCAPP CARES). Objective: This trial will evaluate the acceptability, feasibility, and short-term and long-term effects of NiteCAPP CARES on the sleep and stress mechanisms underlying poor caregiver health and functioning. Methods: Dyads (n=100) consisting of caregivers with chronic insomnia and their coresiding persons with dementia will be recruited from Columbia and surrounding areas in Missouri, United States. Participant dyads will be randomized to 4 weeks (plus 4 bimonthly booster sessions) of NiteCAPP CARES or a web-based sleep hygiene control (NiteCAPP SHARES). Participants will be assessed at baseline, after treatment, and 6- and 12-month follow-ups. The following assessments will be completed by caregivers: 1 week of actigraphy and daily diaries measuring sleep, Insomnia Severity Index, arousal (heart rate variability), inflammation (blood-derived biomarkers: interleukin-6 and C-reactive protein), neurodegeneration (blood-derived biomarkers: plasma amyloid beta [Aβ40 and Aβ42], total tau, and phosphorylated tau [p-tau181 and p-tau217]), cognition (Joggle battery, NIH Toolbox for Assessment of Neurological and Behavioral Function, and Cognitive Failures Questionnaire), stress and burden, health, and mood (depression and anxiety). Persons with dementia will complete 1 week of actigraphy at each time point. Results: Recruitment procedures started in February 2022. All data are expected to be collected by 2026. Full trial results are planned to be published by 2027. Secondary analyses of baseline data will be subsequently published. Conclusions: This randomized controlled trial tests NiteCAPP CARES, a web-based CBT-I for rural caregivers. The knowledge obtained will address not only what outcomes improve but also how and why they improve and for how long, which will help us to modify NiteCAPP CARES to optimize treatment potency and support future pragmatic testing and dissemination. Trial Registration: ClinicalTrials.gov NCT04896775; https://clinicaltrials.gov/ct2/show/NCT04896775 International Registered Report Identifier (IRRID): PRR1-10.2196/37874 %M 35700020 %R 10.2196/37874 %U https://www.researchprotocols.org/2022/6/e37874 %U https://doi.org/10.2196/37874 %U http://www.ncbi.nlm.nih.gov/pubmed/35700020 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e38456 %T Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial %A Brijnath,Bianca %A Baruah,Upasana %A Antoniades,Josefine %A Varghese,Mathew %A Cooper,Claudia %A Dow,Briony %A Kent,Mike %A Loganathan,Santosh %+ National Ageing Research Institute, 34-54 Poplar Road (via Gate 4), Unit 2, Parkville, 3052, Australia, 61 433043708, b.brijnath@nari.edu.au %K dementia %K care %K India %K digital health %K film %D 2022 %7 2.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. Objective: The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. Methods: This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. Results: This study received funding from the Alzheimer’s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India (proposal ID 2020-10137); the Curtin University Human Research Ethics Committee (approval number HRE2020-0735); and the NARI Research Governance Office (site-specific approval dated March 17, 2021). Conclusions: This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Trial Registration: Clinical Trials Registry-India CTRI/2021/01/030403; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=50794 International Registered Report Identifier (IRRID): DERR1-10.2196/38456 %M 35653168 %R 10.2196/38456 %U https://www.researchprotocols.org/2022/6/e38456 %U https://doi.org/10.2196/38456 %U http://www.ncbi.nlm.nih.gov/pubmed/35653168 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33856 %T Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study %A Muurling,Marijn %A Reus,Lianne M %A de Boer,Casper %A Wessels,Sterre C %A Jagesar,Raj R %A Vorstman,Jacob A S %A Kas,Martien J H %A Visser,Pieter Jelle %+ Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 (0)204448527, m.muurling@amsterdamumc.nl %K passive monitoring %K smartphone app %K cognitive impairment %K social behavior %K dementia %K mHealth %K mobile app %K cognitive %K mental health %K social withdrawal %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population. %M 35594063 %R 10.2196/33856 %U https://aging.jmir.org/2022/2/e33856 %U https://doi.org/10.2196/33856 %U http://www.ncbi.nlm.nih.gov/pubmed/35594063 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35224 %T Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review %A Ho,Ka Ying %A Cheung,Po Mang %A Cheng,Tap Wing %A Suen,Wing Yin %A Ho,Hiu Ying %A Cheung,Daphne Sze Ki %+ School of Nursing, The Hong Kong Polytechinc University, Room GH526, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 27664534, daphne.cheung@polyu.edu.hk %K virtual reality %K apathy %K cognitive impairment %K dementia %K systematic review %D 2022 %7 11.5.2022 %9 Review %J JMIR Aging %G English %X Background: Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports of VR interventions are scattered across studies, which has hindered the development and use of the interventions. Objective: This study aimed to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment with regard to the effectiveness, contents, and implementation of the interventions. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The PubMed, Embase, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to March 13, 2022, that reported the effects of VR interventions on apathy in older adults with cognitive impairment. Hand searching and citation chasing were conducted. The results of the included studies were synthesized by using a narrative synthesis. Their quality was appraised by using the Effective Public Health Practice Project quality assessment tool. However, because the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted. Results: A total of 22 studies were identified from the databases, of which 6 (27%) met the inclusion criteria. Of these 6 studies, 2 (33%) were randomized controlled trials, 1 (17%) was a controlled clinical trial, and 3 (50%) were quasi-experimental studies. Individual studies showed significant improvement in apathy and yielded within-group medium to large effect sizes. The level of immersion ranged from low to high. Minor adverse effects were reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used with natural scenes. Most (5/6, 83%) of the studies were conducted in a residential care setting and were implemented by health care professionals or researchers. Safety precautions were taken in most (5/6, 83%) of the studies. Conclusions: Although preliminary evidence shows that VR interventions may be effective and feasible for alleviating apathy in people with cognitive impairment, the methodological limitations in the included studies make it difficult to reach a firm conclusion on these points. The implementation of the interventions was highlighted and discussed. More rigorous studies are encouraged. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021268289; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268289 %M 35544317 %R 10.2196/35224 %U https://aging.jmir.org/2022/2/e35224 %U https://doi.org/10.2196/35224 %U http://www.ncbi.nlm.nih.gov/pubmed/35544317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37014 %T Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets %A Yamada,Yasunori %A Shinkawa,Kaoru %A Kobayashi,Masatomo %A Badal,Varsha D %A Glorioso,Danielle %A Lee,Ellen E %A Daly,Rebecca %A Nebeker,Camille %A Twamley,Elizabeth W %A Depp,Colin %A Nemoto,Miyuki %A Nemoto,Kiyotaka %A Kim,Ho-Cheol %A Arai,Tetsuaki %A Jeste,Dilip V %+ Digital Health, IBM Research, 19-21 Nihonbashi Hakozaki-cho, Chuo-ku, Tokyo, 103-8510, Japan, 81 80 6706 9381, ysnr@jp.ibm.com %K tablet %K behavior analysis %K digital biomarkers %K digital health %K motor control %K cognitive impairment %K dementia %K machine learning %K multicohort %K multination %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. Objective: The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. Methods: We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning–based regression analyses. Results: We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen’s horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001). Conclusions: This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment. %M 35511253 %R 10.2196/37014 %U https://formative.jmir.org/2022/5/e37014 %U https://doi.org/10.2196/37014 %U http://www.ncbi.nlm.nih.gov/pubmed/35511253 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35847 %T Delivering Personalized Recommendations to Support Caregivers of People Living With Dementia: Mixed Methods Study %A Cha,Jinhee %A Peterson,Colleen M %A Millenbah,Ashley N %A Louwagie,Katie %A Baker,Zachary G %A Shah,Ayush %A Jensen,Christine J %A Gaugler,Joseph E %+ Medical School and School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6513523161, cha00003@umn.edu %K caregivers %K caregiving %K Alzheimer %K dementia %K intervention %K COVID-19 %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Estimates suggest that 6.2 million Americans aged ≥65 years are living with Alzheimer dementia in 2021, and by 2060, this number could more than double to 13.8 million. As a result, public health officials anticipate a greater need for caregivers of persons with Alzheimer disease or related dementia and support resources for both people living with dementia and their caregivers. Despite the growing need for dementia caregiver support services, there is a lack of consensus regarding how to tailor these services to best meet the heterogeneous needs of individual caregivers. To fill this gap, Care to Plan (CtP), a web-based tool for caregivers of people living with dementia, was developed to provide tailored support recommendations to dementia caregivers. Objective: The aim of this study is to formally explore the feasibility, acceptability, and utility of CtP for 20 family members of people living with dementia within a health system over a 1-month time period using a mixed methods parallel convergent design. Methods: A moderately sized health system in the mid-Atlantic region was selected as the site for CtP implementation, where 20 caregivers who were family members of people living with dementia were enrolled. The web-based CtP tool was used by caregivers and facilitated by a health care professional (ie, a senior care navigator [SCN]). Caregivers were given a 21-item review checklist to assess barriers and facilitators associated with reviewing CtP with an SCN. Following the 21-item review checklist, semistructured telephone interviews, which included 18 open-ended questions, focused on the facilitators of and barriers to CtP implementation and recommendations for future implementation. Results: Quantitative results suggested that 85% (17/20) of caregivers indicated that CtP was helpful and 90% (18/20) would recommend CtP to someone in a similar situation. The qualitative analysis identified 4 themes regarding facilitators of and barriers to implementation: caregiver factors, SCN factors, CtP tool system factors, and recommendations and resources factors. Conclusions: CtP was found to be not only feasible but also a valuable tool for caregivers seeking resources for themselves and their people living with dementia. Long-term evaluation findings aim to generate results on how CtP can be integrated into care plans for caregivers and how SCNs can provide additional support for caregivers of people living with dementia over an extended period. %M 35503650 %R 10.2196/35847 %U https://aging.jmir.org/2022/2/e35847 %U https://doi.org/10.2196/35847 %U http://www.ncbi.nlm.nih.gov/pubmed/35503650 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32322 %T Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders %A Shin,Marlena H %A McLaren,Jaye %A Ramsey,Alvin %A Sullivan,Jennifer L %A Moo,Lauren %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, 150 South Huntington Avenue (152M), Boston, MA, 02130, United States, 1 857 364 2767, marlena.shin@va.gov %K mild cognitive impairment %K socially assistive robot %K robot technology %K caregiver support %K gerontology %K aging in place %K qualitative research %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders’ overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot’s ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor’s office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home–related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot’s mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots. %M 35503518 %R 10.2196/32322 %U https://aging.jmir.org/2022/2/e32322 %U https://doi.org/10.2196/32322 %U http://www.ncbi.nlm.nih.gov/pubmed/35503518 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35625 %T A Text Messaging Intervention to Support Latinx Family Caregivers of Individuals With Dementia (CuidaTEXT): Development and Usability Study %A Perales-Puchalt,Jaime %A Acosta-Rullán,Mariola %A Ramírez-Mantilla,Mariana %A Espinoza-Kissell,Paul %A Vidoni,Eric %A Niedens,Michelle %A Ellerbeck,Edward %A Hinton,Ladson %A Loera,Linda %A Ramírez,A Susana %A Lara,Esther %A Watts,Amber %A Williams,Kristine %A Resendez,Jason %A Burns,Jeffrey %+ Alzheimer’s Disease Research Center, School of Medicine, University of Kansas Medical Center, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, United States, 1 913 588 3716, jperales@kumc.edu %K Latinx individuals %K mHealth %K dementia %K caregiving %D 2022 %7 28.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Latinx family caregivers of individuals with dementia face many barriers to caregiver support access. Interventions to alleviate these barriers are urgently needed. Objective: This study aimed to describe the development of CuidaTEXT, a tailored SMS text messaging intervention to support Latinx family caregivers of individuals with dementia. Methods: CuidaTEXT is informed by the stress process framework and social cognitive theory. We developed and refined CuidaTEXT using a mixed methods approach that included thematic analysis and descriptive statistics. We followed 6 user-centered design stages, namely, the selection of design principles, software vendor collaboration, evidence-based foundation, caregiver and research and clinical advisory board guidance, sketching and prototyping, and usability testing of the prototype of CuidaTEXT among 5 Latinx caregivers. Results: CuidaTEXT is a bilingual 6-month-long SMS text messaging–based intervention tailored to caregiver needs that includes 1-3 daily automatic messages (n=244) about logistics, dementia education, self-care, social support, end of life, care of the person with dementia, behavioral symptoms, and problem-solving strategies; 783 keyword-driven text messages for further help with the aforementioned topics; live chat interaction with a coach for further help; and a 19-page reference booklet summarizing the purpose and functions of the intervention. The 5 Latinx caregivers who used the prototype of CuidaTEXT scored an average of 97 out of 100 on the System Usability Scale. Conclusions: CuidaTEXT’s prototype demonstrated high usability among Latinx caregivers. CuidaTEXT’s feasibility is ready to be tested. %M 35482366 %R 10.2196/35625 %U https://aging.jmir.org/2022/2/e35625 %U https://doi.org/10.2196/35625 %U http://www.ncbi.nlm.nih.gov/pubmed/35482366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30503 %T 6G and Artificial Intelligence Technologies for Dementia Care: Literature Review and Practical Analysis %A Su,Zhaohui %A Bentley,Barry L %A McDonnell,Dean %A Ahmad,Junaid %A He,Jiguang %A Shi,Feng %A Takeuchi,Kazuaki %A Cheshmehzangi,Ali %A da Veiga,Claudimar Pereira %+ Fundação Dom Cabral, 632 Prefeito Lothário Meissner Ave, Av Princesa Diana, 760 Alphaville, Lagoa dos Ingleses, Nova Lima, 34018-006, Brazil, 55 41 3360 4366, claudimar.veiga@gmail.com %K COVID-19 %K 6G %K digital health %K artificial intelligence %K dementia %K first-perspective health solutions %D 2022 %7 27.4.2022 %9 Review %J J Med Internet Res %G English %X Background: The dementia epidemic is progressing fast. As the world’s older population keeps skyrocketing, the traditional incompetent, time-consuming, and laborious interventions are becoming increasingly insufficient to address dementia patients’ health care needs. This is particularly true amid COVID-19. Instead, efficient, cost-effective, and technology-based strategies, such as sixth-generation communication solutions (6G) and artificial intelligence (AI)-empowered health solutions, might be the key to successfully managing the dementia epidemic until a cure becomes available. However, while 6G and AI technologies hold great promise, no research has examined how 6G and AI applications can effectively and efficiently address dementia patients’ health care needs and improve their quality of life. Objective: This study aims to investigate ways in which 6G and AI technologies could elevate dementia care to address this study gap. Methods: A literature review was conducted in databases such as PubMed, Scopus, and PsycINFO. The search focused on three themes: dementia, 6G, and AI technologies. The initial search was conducted on April 25, 2021, complemented by relevant articles identified via a follow-up search on November 11, 2021, and Google Scholar alerts. Results: The findings of the study were analyzed in terms of the interplay between people with dementia’s unique health challenges and the promising capabilities of health technologies, with in-depth and comprehensive analyses of advanced technology-based solutions that could address key dementia care needs, ranging from impairments in memory (eg, Egocentric Live 4D Perception), speech (eg, Project Relate), motor (eg, Avatar Robot Café), cognitive (eg, Affectiva), to social interactions (eg, social robots). Conclusions: To live is to grow old. Yet dementia is neither a proper way to live nor a natural aging process. By identifying advanced health solutions powered by 6G and AI opportunities, our study sheds light on the imperative of leveraging the potential of advanced technologies to elevate dementia patients’ will to live, enrich their daily activities, and help them engage in societies across shapes and forms. %M 35475733 %R 10.2196/30503 %U https://www.jmir.org/2022/4/e30503 %U https://doi.org/10.2196/30503 %U http://www.ncbi.nlm.nih.gov/pubmed/35475733 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37282 %T The Effect of Transcranial Alternating Current Stimulation With Cognitive Training on Executive Brain Function in Individuals With Dementia: Protocol for a Crossover Randomized Controlled Trial %A Jacobson,Natasha %A Lithgow,Brian %A Jafari Jozani,Mohammad %A Moussavi,Zahra %+ Department of Electrical and Computer Engineering, University of Manitoba, SP-423 Engineering Building, Fort Gary Campus, 97 Dafoe Rd, Winnipeg, MB, R3T 5V6, Canada, 1 204 474 7023, Zahra.Moussavi@Umanitoba.ca %K transcranial alternating current stimulation %K Alzheimer disease %K cognitive impairment %K double blind %K treatment %K placebo-controlled %K randomized %K crossover %K dementia %K cognitive %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although memory and cognitive declines are associated with normal brain aging, they may also be precursors to dementia. Objective: We aim to offer a novel approach to prevent or slow the progress of neurodegenerative dementia, or plausibly, improve the cognitive functions of individuals with dementia. Methods: We will recruit and enroll 75 participants (older than 50 years old with either mild cognitive impairment or probable early or moderate dementia) for this double-blind randomized controlled study to estimate the efficacy of active transcranial alternating current stimulation with cognitive treatment (in comparison with sham transcranial alternating current stimulation). This will be a crossover study; a cycle consists of sham or active treatment for a period of 4 weeks (5 days per week, in two 30-minute sessions with a half-hour break in between), and participants are randomized into 2 groups, with stratification by age, sex, and cognitive level (measured with the Montreal Cognitive Assessment). Outcomes will be assessed before and after each treatment cycle. The primary outcomes are changes in Wechsler Memory Scale Older Adult Battery and Alzheimer Disease Assessment Scale scores. Secondary outcomes are changes in performance on tests of frontal lobe functioning (verbal fluency), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), mood changes (Montgomery-Åsberg Depression Rating Scale), and short-term recall (visual 1-back task). Exploratory outcome measures will also be assessed: static and dynamic vestibular response using electrovestibulography, neuronal changes using functional near-infrared spectroscopy, and change in spatial orientation using virtual reality navigation. Results: As of February 10, 2022, the study is ongoing: 7 patients have been screened, and all were deemed eligible for and enrolled in the study; 4 participants have completed baseline assessments. Conclusions: We anticipate that transcranial alternating current stimulation will be a well-tolerated treatment, with no serious side effects and with considerable short- and long-term cognitive improvements. Trial Registration: Clinicaltrials.gov NCT05203523; https://clinicaltrials.gov/show/NCT05203523 International Registered Report Identifier (IRRID): DERR1-10.2196/37282 %M 35475789 %R 10.2196/37282 %U https://www.researchprotocols.org/2022/4/e37282 %U https://doi.org/10.2196/37282 %U http://www.ncbi.nlm.nih.gov/pubmed/35475789 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e32473 %T Voice-Enabled Intelligent Virtual Agents for People With Amnesia: Systematic Review %A Boumans,Roel %A van de Sande,Yana %A Thill,Serge %A Bosse,Tibor %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 0622372708, roel.boumans@ru.nl %K intelligent virtual agent %K amnesia %K dementia %K Alzheimer %K systematic review %K mobile phone %D 2022 %7 25.4.2022 %9 Review %J JMIR Aging %G English %X Background: Older adults often have increasing memory problems (amnesia), and approximately 50 million people worldwide have dementia. This syndrome gradually affects a patient over a period of 10-20 years. Intelligent virtual agents may support people with amnesia. Objective: This study aims to identify state-of-the-art experimental studies with virtual agents on a screen capable of verbal dialogues with a target group of older adults with amnesia. Methods: We conducted a systematic search of PubMed, SCOPUS, Microsoft Academic, Google Scholar, Web of Science, and CrossRef on virtual agent and amnesia on papers that describe such experiments. Search criteria were (Virtual Agent OR Virtual Assistant OR Virtual Human OR Conversational Agent OR Virtual Coach OR Chatbot) AND (Amnesia OR Dementia OR Alzheimer OR Mild Cognitive Impairment). Risk of bias was evaluated using the QualSyst tool (University of Alberta), which scores 14 study quality items. Eligible studies are reported in a table including country, study design type, target sample size, controls, study aims, experiment population, intervention details, results, and an image of the agent. Results: A total of 8 studies was included in this meta-analysis. The average number of participants in the studies was 20 (SD 12). The verbal interactions were generally short. The usability was generally reported to be positive. The human utterance was seen in 7 (88%) out of 8 studies based on short words or phrases that were predefined in the agent’s speech recognition algorithm. The average study quality score was 0.69 (SD 0.08) on a scale of 0 to 1. Conclusions: The number of experimental studies on talking about virtual agents that support people with memory problems is still small. The details on the verbal interaction are limited, which makes it difficult to assess the quality of the interaction and the possible effects of confounding parameters. In addition, the derivation of the aggregated data was difficult. Further research with extended and prolonged dialogues is required. %M 35468084 %R 10.2196/32473 %U https://aging.jmir.org/2022/2/e32473 %U https://doi.org/10.2196/32473 %U http://www.ncbi.nlm.nih.gov/pubmed/35468084 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28222 %T Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study %A Puthusseryppady,Vaisakh %A Morrissey,Sol %A Aung,Min Hane %A Coughlan,Gillian %A Patel,Martyn %A Hornberger,Michael %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7139, m.hornberger@uea.ac.uk %K Alzheimer disease %K dementia %K spatial disorientation %K getting lost %K outdoor navigation %K risk factors %K environmental %K GPS tracking %K community %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients’ right to safety and autonomy when making outings alone in the community. %M 35451965 %R 10.2196/28222 %U https://aging.jmir.org/2022/2/e28222 %U https://doi.org/10.2196/28222 %U http://www.ncbi.nlm.nih.gov/pubmed/35451965 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36094 %T Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review %A Guemghar,Imane %A Pires de Oliveira Padilha,Paula %A Abdel-Baki,Amal %A Jutras-Aswad,Didier %A Paquette,Jesseca %A Pomey,Marie-Pascale %+ Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 850 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 343 6111 ext 1364, marie-pascale.pomey@umontreal.ca %K social robots %K socially assistive robots %K SARs %K mental health %K mental health services %K dementia %K autism spectrum disorder %K schizophrenia %K depression %K scoping review %D 2022 %7 19.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O’Malley’s framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. %M 35438639 %R 10.2196/36094 %U https://mental.jmir.org/2022/4/e36094 %U https://doi.org/10.2196/36094 %U http://www.ncbi.nlm.nih.gov/pubmed/35438639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34513 %T Associations Between the Digital Clock Drawing Test and Brain Volume: Large Community-Based Prospective Cohort (Framingham Heart Study) %A Yuan,Jing %A Au,Rhoda %A Karjadi,Cody %A Ang,Ting Fang %A Devine,Sherral %A Auerbach,Sanford %A DeCarli,Charles %A Libon,David J %A Mez,Jesse %A Lin,Honghuang %+ Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave North, S7-749, Worcester, MA, 01655, United States, 1 774 455 4881, Honghuang.Lin3@umassmed.edu %K Clock Drawing Test %K digital %K neuropsychological test %K cognitive %K technology %K Boston Process Approach %K neurology %K Framingham Heart Study %K dementia %K Alzheimer %D 2022 %7 15.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital Clock Drawing Test (dCDT) has been recently used as a more objective tool to assess cognition. However, the association between digitally obtained clock drawing features and structural neuroimaging measures has not been assessed in large population-based studies. Objective: We aimed to investigate the association between dCDT features and brain volume. Methods: This study included participants from the Framingham Heart Study who had both a dCDT and magnetic resonance imaging (MRI) scan, and were free of dementia or stroke. Linear regression models were used to assess the association between 18 dCDT composite scores (derived from 105 dCDT raw features) and brain MRI measures, including total cerebral brain volume (TCBV), cerebral white matter volume, cerebral gray matter volume, hippocampal volume, and white matter hyperintensity (WMH) volume. Classification models were also built from clinical risk factors, dCDT composite scores, and MRI measures to distinguish people with mild cognitive impairment (MCI) from those whose cognition was intact. Results: A total of 1656 participants were included in this study (mean age 61 years, SD 13 years; 50.9% women), with 23 participants diagnosed with MCI. All dCDT composite scores were associated with TCBV after adjusting for multiple testing (P value <.05/18). Eleven dCDT composite scores were associated with cerebral white matter volume, but only 1 dCDT composite score was associated with cerebral gray matter volume. None of the dCDT composite scores was associated with hippocampal volume or WMH volume. The classification model for differentiating MCI and normal cognition participants, which incorporated age, sex, education, MRI measures, and dCDT composite scores, showed an area under the curve of 0.897. Conclusions: dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has the potential to be used as a cognitive assessment tool in the clinical diagnosis of MCI. %M 35436225 %R 10.2196/34513 %U https://www.jmir.org/2022/4/e34513 %U https://doi.org/10.2196/34513 %U http://www.ncbi.nlm.nih.gov/pubmed/35436225 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e36825 %T A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study %A Ye,Siao %A Sun,Kevin %A Huynh,Duong %A Phi,Huy Q %A Ko,Brian %A Huang,Bin %A Hosseini Ghomi,Reza %+ BrainCheck, Inc, 5616 Kirby Dr. # 690, Houston, TX, 77005, United States, 1 888 416 0004, bin@braincheck.com %K cognitive test %K mild cognitive impairment %K dementia %K cognitive decline %K repeatable battery %K discriminant analysis %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. Objective: The aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. Methods: A total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. Results: BrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. Conclusions: BrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment. %M 35436212 %R 10.2196/36825 %U https://aging.jmir.org/2022/2/e36825 %U https://doi.org/10.2196/36825 %U http://www.ncbi.nlm.nih.gov/pubmed/35436212 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35677 %T Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah %A Chasteen,Alison L %A Cammer,Allison %A Grewal,Karl S %A Bechard,Lauren E %A Bethell,Jennifer %A Green,Shoshana %A McGilton,Katherine S %A Morgan,Debra %A O’Rourke,Hannah M %A Poole,Lisa %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K coronavirus 2019 %K social media %K stigma %K dementia %K ageism %K COVID-19 %K Twitter %K bias %K infodemiology %K attention %K risk %K impact %K misinformation %K belief %K cognition %K cognitive impairment %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. %M 35290197 %R 10.2196/35677 %U https://aging.jmir.org/2022/1/e35677 %U https://doi.org/10.2196/35677 %U http://www.ncbi.nlm.nih.gov/pubmed/35290197 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31209 %T Optimizing Existing Mental Health Screening Methods in a Dementia Screening and Risk Factor App: Observational Machine Learning Study %A Kuleindiren,Narayan %A Rifkin-Zybutz,Raphael Paul %A Johal,Monika %A Selim,Hamzah %A Palmon,Itai %A Lin,Aaron %A Yu,Yizhou %A Alim-Marvasti,Ali %A Mahmud,Mohammad %+ Mindset Technologies Ltd, 3rd Floor, 5 Chancery Lane, London, WC2A 1LG, United Kingdom, 44 02081522341, raphael.rifkinzybutz@meetmindset.com %K depression %K anxiety %K screening %K research method %K questionnaire %K precision %K dementia %K cognition %K risk factors %K machine learning %K prediction %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindstep is an app that aims to improve dementia screening by assessing cognition and risk factors. It considers important clinical risk factors, including prodromal symptoms, mental health disorders, and differential diagnoses of dementia. The 9-item Patient Health Questionnaire for depression (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) are widely validated and commonly used scales used in screening for depression and anxiety disorders, respectively. Shortened versions of both (PHQ-2/GAD-2) have been produced. Objective: We sought to develop a method that maintained the brevity of these shorter questionnaires while maintaining the better precision of the original questionnaires. Methods: Single questions were designed to encompass symptoms covered in the original questionnaires. Answers to these questions were combined with PHQ-2/GAD-2, and anonymized risk factors were collected by Mindset4Dementia from 2235 users. Machine learning models were trained to use these single questions in combination with data already collected by the app: age, response to a joke, and reporting of functional impairment to predict binary and continuous outcomes as measured using PHQ-9/GAD-7. Our model was developed with a training data set by using 10-fold cross-validation and a holdout testing data set and compared to results from using the shorter questionnaires (PHQ-2/GAD-2) alone to benchmark performance. Results: We were able to achieve superior performance in predicting PHQ-9/GAD-7 screening cutoffs compared to PHQ-2 (difference in area under the curve 0.04, 95% CI 0.00-0.08, P=.02) but not GAD-2 (difference in area under the curve 0.00, 95% CI –0.02 to 0.03, P=.42). Regression models were able to accurately predict total questionnaire scores in PHQ-9 (R2=0.655, mean absolute error=2.267) and GAD-7 (R2=0.837, mean absolute error=1.780). Conclusions: We app-adapted PHQ-4 by adding brief summary questions about factors normally covered in the longer questionnaires. We additionally trained machine learning models that used the wide range of additional information already collected in Mindstep to make a short app-based screening tool for affective disorders, which appears to have superior or equivalent performance to well-established methods. %M 35315786 %R 10.2196/31209 %U https://formative.jmir.org/2022/3/e31209 %U https://doi.org/10.2196/31209 %U http://www.ncbi.nlm.nih.gov/pubmed/35315786 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e31552 %T The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study %A Albers,Elizabeth A %A Mikal,Jude %A Millenbah,Ashley %A Finlay,Jessica %A Jutkowitz,Eric %A Mitchell,Lauren %A Horn,Brenna %A Gaugler,Joseph E %+ Division of Health Policy and Management, School of Public Health, University of Minnesota, D351 Mayo, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6124540415, alber304@umn.edu %K social isolation %K dementia %K caregiving - informal %K aging in place %K caregivers %K aging %K elderly %K pandemic %K COVID-19 %K mental health %K technology use %K health technology %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. %M 35134748 %R 10.2196/31552 %U https://aging.jmir.org/2022/1/e31552 %U https://doi.org/10.2196/31552 %U http://www.ncbi.nlm.nih.gov/pubmed/35134748 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e32352 %T Impact of Biological and Lifestyle Factors on Cognitive Aging and Work Ability in the Dortmund Vital Study: Protocol of an Interdisciplinary, Cross-sectional, and Longitudinal Study %A Gajewski,Patrick D %A Getzmann,Stephan %A Bröde,Peter %A Burke,Michael %A Cadenas,Cristina %A Capellino,Silvia %A Claus,Maren %A Genç,Erhan %A Golka,Klaus %A Hengstler,Jan G %A Kleinsorge,Thomas %A Marchan,Rosemarie %A Nitsche,Michael A %A Reinders,Jörg %A van Thriel,Christoph %A Watzl,Carsten %A Wascher,Edmund %+ Leibniz Research Centre for Working Environment and Human Factors (IfADo) at the Technical University of Dortmund, Ardeystr. 67, Dortmund, 44139, Germany, 49 231 1084 383, gajewski@ifado.de %K cognitive aging %K genetic polymorphisms %K immunology %K metabolism %K latent infections %K stress %K occupational health %K cardiovascular system %K neuropsychology %K magnetic resonance imaging %K electroencephalography %K lifespan %K lifestyle %K longitudinal study %K biomarkers %K longevity %K aging. %D 2022 %7 14.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous research revealed several biological and environmental factors modulating cognitive functioning over a human’s lifespan. However, the relationships and interactions between biological factors (eg, genetic polymorphisms, immunological parameters, metabolic products, or infectious diseases) and environmental factors (eg, lifestyle, physical activity, nutrition, and work type or stress at work) as well as their impact on cognitive functions across the lifespan are still poorly understood with respect to their complexity. Objective: The goal of the Dortmund Vital Study is to validate previous hypotheses as well as generate and validate new hypotheses about the relationships among aging, working conditions, genetic makeup, stress, metabolic functions, the cardiovascular system, the immune system, and mental performance over the human lifespan with a focus on healthy working adults. The Dortmund Vital Study is a multidisciplinary study involving the Departments of Ergonomics, Immunology, Psychology and Neurosciences, and Toxicology at the Leibniz Research Centre for Working Environment and Human Factors at the Technical University of Dortmund (IfADo) in Germany, as well as several national and international partners. Methods: The Dortmund Vital Study is designed as a combined cross-sectional and longitudinal study. Approximately 600 healthy subjects aged between 20 and 70 years will participate. A wide range of demographic, psychological, behavioral, sensory, cardiovascular, immunological, and biochemical data, a comprehensive electroencephalography (EEG)-based cognitive test battery as well as structural and functional magnetic resonance imaging (MRI) have been included in the study. Results: The study was approved by the Ethics Committee of IfADo in October 2015. The baseline testing was conducted between 2016 and 2021 and will be repeated every 5 years (3 follow-up measures until 2035). As of March 2020 (until the outbreak of the COVID-19 pandemic), 593 participants have been enrolled. Some results from the cross-sectional part of the study were already published, further results will be published soon. Longitudinal data will be analyzed and published by 2025. Conclusions: We anticipate that the study will shed light on sources of interindividual differences in the alterations of cognitive functioning with increasing age and reveal biological and lifestyle markers contributing to work ability, longevity, and healthy aging on the one hand, and to risk factors for cognitive decline, mild cognitive impairment, or even dementia on the other hand. Trial Registration: ClinicalTrials.gov NCT05155397; https://clinicaltrials.gov/ct2/show/NCT05155397 International Registered Report Identifier (IRRID): DERR1-10.2196/32352 %M 35285810 %R 10.2196/32352 %U https://www.researchprotocols.org/2022/3/e32352 %U https://doi.org/10.2196/32352 %U http://www.ncbi.nlm.nih.gov/pubmed/35285810 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e34592 %T The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis %A Abd-alrazaq,Alaa %A Alajlani,Mohannad %A Alhuwail,Dari %A Toro,Carla T %A Giannicchi,Anna %A Ahmed,Arfan %A Makhlouf,Ahmed %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K cognitive training %K exergames %K mild cognitive impairment %K Alzheimer disease %K dementia %K global cognition %K systematic review %K meta-analysis %D 2022 %7 10.3.2022 %9 Review %J JMIR Serious Games %G English %X Background: Cognitive impairment is a mental disorder that commonly affects elderly people. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological intervention for improving cognitive abilities. The effectiveness and safety of serious games for improving cognitive abilities have been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness and safety of serious games for improving cognitive abilities among elderly people with cognitive impairment. Methods: A systematic review of randomized controlled trials (RCTs) was conducted. The following 8 electronic databases were searched: MEDLINE, Embase, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also screened reference lists of the included studies and relevant reviews, as well as checked studies citing our included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Fifteen studies met the eligibility criteria among 466 citations retrieved. Of those, 14 RCTs were eventually included in the meta-analysis. We found that, regardless of their type, serious games were more effective than no intervention (P=.04) and conventional exercises (P=.002) for improving global cognition among elderly people with cognitive impairment. Further, a subgroup analysis showed that cognitive training games were more effective than no intervention (P=.05) and conventional exercises (P<.001) for improving global cognition among elderly people with cognitive impairment. Another subgroup analysis demonstrated that exergames (a category of serious games that includes physical exercises) are as effective as no intervention and conventional exercises (P=.38) for improving global cognition among elderly people with cognitive impairment. Although some studies found adverse events from using serious games, the number of adverse events (ie, falls and exacerbations of pre-existing arthritis symptoms) was comparable between the serious game and control groups. Conclusions: Serious games and specifically cognitive training games have the potential to improve global cognition among elderly people with cognitive impairment. However, our findings remain inconclusive because the quality of evidence in all meta-analyses was very low, mainly due to the risk of bias raised in the majority of the included studies, high heterogeneity of the evidence, and imprecision of total effect sizes. Therefore, psychologists, psychiatrists, and patients should consider offering serious games as a complement and not a substitute to existing interventions until further more robust evidence is available. Further studies are needed to assess the effect of exergames, the safety of serious games, and their long-term effects. %M 35266877 %R 10.2196/34592 %U https://games.jmir.org/2022/1/e34592 %U https://doi.org/10.2196/34592 %U http://www.ncbi.nlm.nih.gov/pubmed/35266877 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e28333 %T Predicting Working Memory in Healthy Older Adults Using Real-Life Language and Social Context Information: A Machine Learning Approach %A Ferrario,Andrea %A Luo,Minxia %A Polsinelli,Angelina J %A Moseley,Suzanne A %A Mehl,Matthias R %A Yordanova,Kristina %A Martin,Mike %A Demiray,Burcu %+ Chair of Technology Marketing, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 799282484, aferrario@ethz.ch %K cognitive aging %K language complexity %K social context %K machine learning %K natural language processing %K Electronically Activated Recorder (EAR) %K behavioral indicators %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Language use and social interactions have demonstrated a close relationship with cognitive measures. It is important to improve the understanding of language use and behavioral indicators from social context to study the early prediction of cognitive decline among healthy populations of older adults. Objective: This study aimed at predicting an important cognitive ability, working memory, of 98 healthy older adults participating in a 4-day-long naturalistic observation study. We used linguistic measures, part-of-speech (POS) tags, and social context information extracted from 7450 real-life audio recordings of their everyday conversations. Methods: The methods in this study comprise (1) the generation of linguistic measures, representing idea density, vocabulary richness, and grammatical complexity, as well as POS tags with natural language processing (NLP) from the transcripts of real-life conversations and (2) the training of machine learning models to predict working memory using linguistic measures, POS tags, and social context information. We measured working memory using (1) the Keep Track test, (2) the Consonant Updating test, and (3) a composite score based on the Keep Track and Consonant Updating tests. We trained machine learning models using random forest, extreme gradient boosting, and light gradient boosting machine algorithms, implementing repeated cross-validation with different numbers of folds and repeats and recursive feature elimination to avoid overfitting. Results: For all three prediction routines, models comprising linguistic measures, POS tags, and social context information improved the baseline performance on the validation folds. The best model for the Keep Track prediction routine comprised linguistic measures, POS tags, and social context variables. The best models for prediction of the Consonant Updating score and the composite working memory score comprised POS tags only. Conclusions: The results suggest that machine learning and NLP may support the prediction of working memory using, in particular, linguistic measures and social context information extracted from the everyday conversations of healthy older adults. Our findings may support the design of an early warning system to be used in longitudinal studies that collects cognitive ability scores and records real-life conversations unobtrusively. This system may support the timely detection of early cognitive decline. In particular, the use of a privacy-sensitive passive monitoring technology would allow for the design of a program of interventions to enable strategies and treatments to decrease or avoid early cognitive decline. %M 35258457 %R 10.2196/28333 %U https://aging.jmir.org/2022/1/e28333 %U https://doi.org/10.2196/28333 %U http://www.ncbi.nlm.nih.gov/pubmed/35258457 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32516 %T Refining a Digital Therapeutic Platform for Home Care Agencies in Dementia Care to Elicit Stakeholder Feedback: Focus Group Study With Stakeholders %A Gilson,Aaron %A Gassman,Michele %A Dodds,Debby %A Lombardo,Robin %A Ford II,James H %A Potteiger,Michael %+ Social & Administrative Pharmacy Division, School of Pharmacy, University of Wisconsin–Madison, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K dementia %K technology %K mobile app %K home care %K focus groups %K qualitative research %K digital therapeutics %K value-based care %K aging in place %K caregiving %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Persons living with dementia require increasing levels of care, and the care model has evolved. The Centers for Medicare and Medicaid Services is transitioning long-term care services from institutional care to home- or community-based services, including reimbursement for nonclinical services. Although home care companies are positioned to handle this transition, they need innovative solutions to address the special challenges posed by caring for persons living with dementia. To live at home longer, these persons require support from formal caregivers (FCGs; ie, paid professionals), who often lack knowledge of their personal histories and have high turnover, or informal caregivers (eg, family or friends), who may have difficulty coping with behavioral and psychological symptoms of dementia. The Generation Connect platform was developed to support these individuals and their formal and informal caregivers. In preliminary studies, the platform improved mood and influenced caregiver satisfaction. To enhance platform effectiveness, Generation Connect received a grant from the National Institutes of Health Small Business Innovation Research to improve clinical outcomes, reduce health care costs, and lower out-of-pocket costs for persons living with dementia who receive care through home care agencies. Objective: This study aims to evaluate information elicited from a series of stakeholder focus groups to understand existing processes, needs, barriers, and goals for the use of the Generation Connect platform by home care agencies and formal and informal caregivers. Methods: A series of focus groups were conducted with home care agency corporate leadership, home care agency franchise owners, home care agency FCGs, and informal caregivers of persons living with dementia. The qualitative approach allowed for unrestricted idea generation that best informed the platform development to enable home care providers to differentiate their dementia care services, involve informal caregivers, improve FCG well-being, and extend the ability of persons living with dementia to age in place. Using the Technology-Enabled Caregiving in the Home framework, an inductive and iterative content analysis was conducted to identify thematic categories from the transcripts. Results: Overall, 39 participants participated across the 6 stakeholder focus groups. The following five overarching themes were identified: technology related; care services; data, documentation, and outcomes; cost, finance, and resources; and resources for caregivers. Within each theme, the most frequent subthemes were identified. Exemplar stakeholder group statements provided support for each of the identified themes. Conclusions: The focus group results will inform the further development of the Generation Connect platform to reduce the burden of caregiving for persons living with dementia, evaluate changes in cognition, preserve functional independence, and promote caregiver engagement between these individuals. The next step is to evaluate the effectiveness of the revised platform in the National Institutes of Health Small Business Innovation Research phase 2 clinical trial to assess the efficacy of its evidence-based interventions and market viability. %M 35234657 %R 10.2196/32516 %U https://aging.jmir.org/2022/1/e32516 %U https://doi.org/10.2196/32516 %U http://www.ncbi.nlm.nih.gov/pubmed/35234657 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34688 %T Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study %A Bartlett,Larissa %A Doherty,Kathleen %A Farrow,Maree %A Kim,Sarang %A Hill,Edward %A King,Anna %A Alty,Jane %A Eccleston,Claire %A Kitsos,Alex %A Bindoff,Aidan %A Vickers,James C %+ Wicking Dementia Research and Education Centre, University of Tasmania, Medical Sciences Precinct, 17 Liverpool Street, Hobart, 7000, Australia, 1800 982 600, larissa.bartlett@utas.edu.au %K public health %K online %K prospective research cohort %K dementia %K aging %K older adult %K neurodegenerative %K modifiable risk factors %K risk reduction %K prevention %K lifestyle and behaviors %K lifestyle %K behavior change %K intervention %K risk %K cognition %K blood-based dementia biomarkers %K research translation %D 2022 %7 1.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed. Objective: We aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels. Methods: The Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time. Results: In the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing. Conclusions: Recruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context. International Registered Report Identifier (IRRID): DERR1-10.2196/34688 %M 35230251 %R 10.2196/34688 %U https://www.researchprotocols.org/2022/3/e34688 %U https://doi.org/10.2196/34688 %U http://www.ncbi.nlm.nih.gov/pubmed/35230251 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e29224 %T The Usability and Impact of a Low-Cost Pet Robot for Older Adults and People With Dementia: Qualitative Content Analysis of User Experiences and Perceptions on Consumer Websites %A Koh,Wei Qi %A Whelan,Sally %A Heins,Pascale %A Casey,Dympna %A Toomey,Elaine %A Dröes,Rose-Marie %+ School of Nursing and Midwifery, College of Medicine, Nursing & Health Sciences, National University of Ireland, University Road, Galway, H91TK33, Ireland, 353 91493687, weiqi.koh@nuigalway.ie %K social robot %K pet robots %K low-cost robot %K dementia %K older adults %K qualitative research %K qualitative content analysis %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Worldwide, populations are aging exponentially. Older adults and people with dementia are especially at risk of social isolation and loneliness. Social robots, including robotic pets, have had positive impacts on older adults and people with dementia by providing companionship, improving mood, reducing agitation, and facilitating social interaction. Nevertheless, the issue of affordability can hinder technology access. The Joy for All (JfA) robotic pets have showed promise as examples of low-cost alternatives. However, there has been no research that investigated the usability and impact of such low-cost robotic pets based on perceptions and experiences of its use with older adults and people with dementia. Objective: The aim of our study was to explore the usability and impact of the JfA robotic cat, as an example of a low-cost robot, based on perceptions and experiences of using the JfA cat for older adults and people with dementia. Methods: We used a novel methodology of analyzing a large volume of information that was uploaded by reviewers of the JfA cat onto online consumer review sites. Data were collected from 15 consumer websites. This provided a total of 2445 reviews. Next, all reviews were screened. A total of 1327 reviews that contained information about use of the JfA cat for older adults or people with dementia were included for analysis. These were reviews that contained terms relating to “older adults,” “dementia,” and “institutional care” and were published in the English language. Descriptive statistics was used to characterize available demographic information, and textual data were qualitatively analyzed using inductive content analysis. Results: Most reviews were derived from consumer sites in the United States, and most reviewers were family members of users (ie, older adults and people with dementia). Based on the qualitative content analysis, 5 key themes were generated: prior expectations, perceptions, meaningful activities, impacts, and practicalities. Reviewers had prior expectations of the JfA cat, which included circumstantial reasons that prompted them to purchase this technology. Their perceptions evolved after using the technology, where most reported positive perceptions about their appearance and interactivity. The use of the robot provided opportunities for users to care for it and incorporate it into their routine. Finally, reviewers also shared information about the impacts of device and practicalities related to its use. Conclusions: This study provides useful knowledge about the usability and impact of a low-cost pet robot, based on experiences and perceptions of its use. These findings can help researchers, robot developers, and clinicians understand the viability of using low-cost robotic pets to benefit older adults and people with dementia. Future research should consider evaluating design preferences for robotic pets, and compare the effects of low-cost robotic pets with other more technologically advanced robotic pets. %M 35191844 %R 10.2196/29224 %U https://aging.jmir.org/2022/1/e29224 %U https://doi.org/10.2196/29224 %U http://www.ncbi.nlm.nih.gov/pubmed/35191844 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32117 %T Immersive Virtual Reality–Based Cognitive Intervention for the Improvement of Cognitive Function, Depression, and Perceived Stress in Older Adults With Mild Cognitive Impairment and Mild Dementia: Pilot Pre-Post Study %A Zhu,KaiYan %A Zhang,QiongYao %A He,BingWei %A Huang,MeiZhen %A Lin,Rong %A Li,Hong %+ Research Center for Nursing Theory and Practice, Department of Nursing, Fujian Provincial Hospital, No 134, Dongjie Street, Gulou District, Fuzhou, 350001, China, 86 13705070219, leehong99@126.com %K cognitive intervention %K dementia %K immersive virtual reality %K mild cognitive impairment %K cognitive impairment %K virtual reality %K VR %K older patients %K usability %K memory %K stress %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The incidence of dementia is increasing annually, resulting in varying degrees of adverse effects for individuals, families, and society. With the continuous development of computer information technology, cognitive interventions are constantly evolving. The use of immersive virtual reality (IVR) as a cognitive intervention for older adults with mild cognitive impairment (MCI) and mild dementia (MD) is promising, although only few studies have focused on its use. Objective: The Chinese virtual supermarket (CVSM) IVR system was developed to provide a comprehensive and individual cognitive intervention program for older patients with MCI and MD. The aim of this study was to explore the feasibility and clinical effectiveness of this 5-week IVR-based cognitive intervention. Methods: A pretest-posttest study design was conducted with 31 older adults with MCI and MD from August 2020 to January 2021. All participants participated in a 5-week immersive virtual cognitive training program using the CVSM system. Feasibility was assessed as the incidence and severity of cybersickness symptoms and participant satisfaction based on questionnaires conducted after the intervention. Clinical effectiveness was evaluated using neuropsychological assessments, including several commonly used measures of cognitive function, depression, perceived stress, and activities of daily living. Measurements were obtained at baseline and after the intervention period. Results: A total of 18 patients with MCI (mean age 82.94 [SD 5.44] years; 12 females) and 13 patients with MD (mean age 85.7 [SD 4.67] years, 10 females) participated in this pilot study. Both groups showed significant improvements in all cognitive function measurements (P<.001). The MD group had a significantly greater improvement in general cognitive function compared to the MCI group in Montreal Cognitive Assessment Scale, Symbol Digit Modalities Test, Shape Trail Test, and Auditory Verbal Learning Test. Furthermore, an intervention effect was observed in the improvement of perceived stress (P=.048 for MD group, P=.03 for MCI group ). Conclusions: The use of the CVSM system may be effective in enhancing the cognitive function of patients with MCI and MD, including general cognitive function, memory, executive function, and attention. IVR technology enriches cognitive intervention approaches and provides acceptable, professional, personalized, and interesting cognitive training for older adults with cognitive impairment. Trial Registration: ClinicalTrials ChiCTR2100043753; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2100043753 %M 35188466 %R 10.2196/32117 %U https://games.jmir.org/2022/1/e32117 %U https://doi.org/10.2196/32117 %U http://www.ncbi.nlm.nih.gov/pubmed/35188466 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31841 %T Intervention for a Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity Study: Protocol for a Randomized Controlled Trial %A Gray,Michelle %A Madero,Erica N %A Gills,Joshua L %A Paulson,Sally %A Jones,Megan D %A Campitelli,Anthony %A Myers,Jennifer %A Bott,Nicholas T %A Glenn,Jordan M %+ Exercise Science Research Center, Department of Health, Human Performance, and Recreation, University of Arkansas, 1 University of Arkansas, Fayetteville, AR, 72701, United States, 1 4795756713, rgray@uark.edu %K health coaching %K Alzheimer risk %K digital health %K mobile phone %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, more than 6 million adults live with Alzheimer disease (AD) that affects 1 out of every 3 older adults. Although there is no cure for AD currently, lifestyle-based interventions aimed at slowing the rate of cognitive decline or delaying the onset of AD have shown promising results. However, most studies primarily focus on older adults (>55 years) and use in-person interventions. Objective: The aim of this study is to determine the effects of a 2-year digital lifestyle intervention on AD risk among at-risk middle-aged and older adults (45-75 years) compared with a health education control. Methods: The lifestyle intervention consists of a digitally delivered, personalized health coaching program that directly targets the modifiable risk factors for AD. The primary outcome measure is AD risk as determined by the Australian National University-Alzheimer Disease Risk Index; secondary outcome measures are functional fitness, blood biomarkers (inflammation, glucose, cholesterol, and triglycerides), and cognitive function (Repeatable Battery for the Assessment of Neuropsychological Status and Neurotrack Cognitive Battery). Screening commenced in January 2021 and was completed in June 2021. Results: Baseline characteristics indicate no difference between the intervention and control groups for AD risk (mean −1.68, SD 7.31; P=.90). Conclusions: The intervention in the Digital, Cognitive, Multi-domain Alzheimer Risk Velocity is uniquely designed to reduce the risk of AD through a web-based health coaching experience that addresses the modifiable lifestyle-based risk factors. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789 International Registered Report Identifier (IRRID): DERR1-10.2196/31841 %M 35119374 %R 10.2196/31841 %U https://www.researchprotocols.org/2022/2/e31841 %U https://doi.org/10.2196/31841 %U http://www.ncbi.nlm.nih.gov/pubmed/35119374 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29837 %T Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review %A Gillam,Juliet %A Davies,Nathan %A Aworinde,Jesutofunmi %A Yorganci,Emel %A Anderson,Janet E %A Evans,Catherine %+ Cicely Saunders Institute, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom, 44 7500 708 293, juliet.h.gillam@kcl.ac.uk %K telemedicine %K implementation science %K dementia %K long-term care %K systematic review %D 2022 %7 3.2.2022 %9 Review %J J Med Internet Res %G English %X Background: As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective: The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods: A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results: A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions: Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care. %M 35113029 %R 10.2196/29837 %U https://www.jmir.org/2022/2/e29837 %U https://doi.org/10.2196/29837 %U http://www.ncbi.nlm.nih.gov/pubmed/35113029 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30410 %T Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study %A Eastman,Jennifer A %A Kaup,Allison R %A Bahorik,Amber L %A Butcher,Xochitl %A Attarha,Mouna %A Marcus,Gregory M %A Pletcher,Mark J %A Olgin,Jeffrey E %A Barnes,Deborah E %A Yaffe,Kristine %+ San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA, 94121, United States, 1 951 760 6711, jennifer.eastman@ucsf.edu %K mHealth %K internet %K mobile health %K digital health %K eHealth %K cardiovascular %K risk factors %K cognition %K cognitive impairment %K remote cognitive assessment %K aging %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults with cardiovascular disease risk factors (CVRFs) are also at increased risk of developing cognitive decline and dementia. However, it is often difficult to study the relationships between CVRFs and cognitive function because cognitive assessment typically requires time-consuming in-person neuropsychological evaluations that may not be feasible for real-world situations. Objective: We conducted a proof-of-concept study to determine if the association between CVRFs and cognitive function could be detected using web-based, self-administered cognitive tasks and CVRF assessment. Methods: We recruited 239 participants aged ≥50 years (mean age 62.7 years, SD 8.8; 42.7% [n=102] female, 88.7% [n=212] White) who were enrolled in the Health eHeart Study, a web-based platform focused on cardiac disease. The participants self-reported CVRFs (hypertension, high cholesterol, diabetes, and atrial fibrillation) using web-based health surveys between August 2016 and July 2018. After an average of 3 years of follow-up, we remotely evaluated episodic memory, working memory, and executive function via the web-based Posit Science platform, BrainHQ. Raw data were normalized and averaged into 3 domain scores. We used linear regression models to examine the association between CVRFs and cognitive function. Results: CVRF prevalence was 62.8% (n=150) for high cholesterol, 45.2% (n=108) for hypertension, 10.9% (n=26) for atrial fibrillation, and 7.5% (n=18) for diabetes. In multivariable models, atrial fibrillation was associated with worse working memory (β=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (β=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (β=-.27, 95% CI -0.44 to -0.11). Diabetes and high cholesterol were not associated with cognitive performance. Conclusions: Self-administered web-based tools can be used to detect both CVRFs and cognitive health. We observed that atrial fibrillation and hypertension were associated with worse cognitive function even in those in their 60s and 70s. The potential of mobile assessments to detect risk factors for cognitive aging merits further investigation. %M 35107430 %R 10.2196/30410 %U https://formative.jmir.org/2022/2/e30410 %U https://doi.org/10.2196/30410 %U http://www.ncbi.nlm.nih.gov/pubmed/35107430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e29230 %T Aerobic Exercise in HIV-Associated Neurocognitive Disorders: Protocol for a Randomized Controlled Trial %A Nweke,Martins %A Mshunqane,Nombeko %A Govender,Nalini %A Akinpelu,Aderonke %A Ogunniyi,Adesola %+ Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, 15 4th Avenue Trans-Ekulu, Enugu, 400281, Nigeria, 234 07038734685, martins.nweke@gmail.com %K HIV %K neurocognitive disorder %K exercise %K rehabilitation %K quality of life %K activity limitation %D 2022 %7 31.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. Objective: This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Methods: At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. Results: This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. Conclusions: This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. Trial Registration: Pan African Clinical Trials Registry PACTR202009483415745; https://tinyurl.com/2p97zpu9 International Registered Report Identifier (IRRID): PRR1-10.2196/29230 %M 35099405 %R 10.2196/29230 %U https://www.researchprotocols.org/2022/1/e29230 %U https://doi.org/10.2196/29230 %U http://www.ncbi.nlm.nih.gov/pubmed/35099405 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34475 %T The Use of a Computerized Cognitive Assessment to Improve the Efficiency of Primary Care Referrals to Memory Services: Protocol for the Accelerating Dementia Pathway Technologies (ADePT) Study %A Kalafatis,Chris %A Modarres,Mohammad Hadi %A Apostolou,Panos %A Tabet,Naji %A Khaligh-Razavi,Seyed-Mahdi %+ Cognetivity Neurosciences Ltd, 3 Waterhouse Square, London, EC1N 2SW, United Kingdom, 44 020 3002 362, seyed@cognetivity.com %K primary health care %K general practice %K dementia %K cognitive assessment %K artificial intelligence %K early diagnosis %K cognition %K assessment %K efficiency %K diagnosis %K COVID-19 %K memory %K mental health %K impairment %K screening %K detection %K efficiency %D 2022 %7 27.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerized cognitive tests, such as the Integrated Cognitive Assessment (ICA), as prominent candidates for adoption in clinical practice both during the pandemic and for post-COVID-19 implementation as part of health care innovation. Objective: The aim of the Accelerating Dementia Pathway Technologies (ADePT) study is to develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment to improve the efficiency of the dementia care pathway. Methods: Patients who have been referred to a memory clinic by a general practitioner (GP) are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as National Health Service reference costing data will be used to assess the potential health and economic benefits of the use of the ICA in the dementia diagnosis pathway. Results: The ADePT study was funded in January 2020 by Innovate UK (Project Number 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially, the study was designed for in-person visits at the memory clinic; however, in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. Conclusions: The ADePT study aims to improve the efficiency of the dementia care pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardized, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision support system that can signpost accordingly can reduce unnecessary referrals, service backlog, and assessment variability. Trial Registration: ISRCTN 16596456; https://www.isrctn.com/ISRCTN16596456 International Registered Report Identifier (IRRID): DERR1-10.2196/34475 %M 34932495 %R 10.2196/34475 %U https://www.researchprotocols.org/2022/1/e34475 %U https://doi.org/10.2196/34475 %U http://www.ncbi.nlm.nih.gov/pubmed/34932495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29219 %T Patterns of Symptom Tracking by Caregivers and Patients With Dementia and Mild Cognitive Impairment: Cross-sectional Study %A Dunn,Taylor %A Howlett,Susan E %A Stanojevic,Sanja %A Shehzad,Aaqib %A Stanley,Justin %A Rockwood,Kenneth %+ Geriatric Medicine Research Unit, Nova Scotia Health Authority, 1421-5955 Veterans Memorial Lane, Halifax, NS, B3H 2E1, Canada, 1 902 473 8687, research@ardeaoutcomes.com %K dementia %K mild cognitive impairment %K real-world evidence %K patient-centric outcomes %K machine learning %K dementia stage %K Alzheimer disease %K symptom tracking %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with dementia and mild cognitive impairment (MCI) experience a wide variety of symptoms and challenges that trouble them. To address this heterogeneity, numerous standardized tests are used for diagnosis and prognosis. myGoalNav Dementia is a web-based tool that allows individuals with impairments and their caregivers to identify and track outcomes of greatest importance to them, which may be a less arbitrary and more sensitive way of capturing meaningful change. Objective: We aim to explore the most frequent and important symptoms and challenges reported by caregivers and people with dementia and MCI and how this varies according to disease severity. Methods: This cross-sectional study involved 3909 web-based myGoalNav users (mostly caregivers of people with dementia or MCI) who completed symptom profiles between 2006 and 2019. To make a symptom profile, users selected their most personally meaningful or troublesome dementia-related symptoms to track over time. Users were also asked to rank their chosen symptoms from least to most important, which we called the symptom potency. As the stage of disease for these web-based users was unknown, we applied a supervised staging algorithm, previously trained on clinician-derived data, to classify each profile into 1 of 4 stages: MCI and mild, moderate, and severe dementia. Across these stages, we compared symptom tracking frequency, symptom potency, and the relationship between frequency and potency. Results: Applying the staging algorithm to the 3909 user profiles resulted in 917 (23.46%) MCI, 1596 (40.83%) mild dementia, 514 (13.15%) moderate dementia, and 882 (22.56%) severe dementia profiles. We found that the most frequent symptoms in MCI and mild dementia profiles were similar and comprised early hallmarks of dementia (eg, recent memory and language difficulty). As the stage increased to moderate and severe, the most frequent symptoms were characteristic of loss of independent function (eg, incontinence) and behavioral problems (eg, aggression). The most potent symptoms were similar between stages and generally reflected disruptions in everyday life (eg, problems with hobbies or games, travel, and looking after grandchildren). Symptom frequency was negatively correlated with potency at all stages, and the strength of this relationship increased with increasing disease severity. Conclusions: Our results emphasize the importance of patient-centricity in MCI and dementia studies and illustrate the valuable real-world evidence that can be collected with digital tools. Here, the most frequent symptoms across the stages reflected our understanding of the typical disease progression. However, the symptoms that were ranked as most personally important by users were generally among the least frequently selected. Through individualization, patient-centered instruments such as myGoalNav can complement standardized measures by capturing these infrequent but potent outcomes. %M 35084341 %R 10.2196/29219 %U https://www.jmir.org/2022/1/e29219 %U https://doi.org/10.2196/29219 %U http://www.ncbi.nlm.nih.gov/pubmed/35084341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27641 %T A Novel Virtual Reality Assessment of Functional Cognition: Validation Study %A Porffy,Lilla Alexandra %A Mehta,Mitul A %A Patchitt,Joel %A Boussebaa,Celia %A Brett,Jack %A D’Oliveira,Teresa %A Mouchlianitis,Elias %A Shergill,Sukhi S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 07738244217, lilla.a.porffy@kcl.ac.uk %K virtual reality %K virtual reality assessment %K cognition %K functional cognition %K functional capacity %K neuropsychological testing %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task—VStore. Objective: This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline. Methods: A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively. Results: Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve. Conclusions: Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline. %M 35080501 %R 10.2196/27641 %U https://www.jmir.org/2022/1/e27641 %U https://doi.org/10.2196/27641 %U http://www.ncbi.nlm.nih.gov/pubmed/35080501 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25760 %T Impact of Internet Use on Cognitive Decline in Middle-Aged and Older Adults in China: Longitudinal Observational Study %A Yu,Xinyue %A Mu,Aruhan %A Wu,Xiang %A Zhou,Liqin %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China, 86 15927686325, zhoulq@hust.edu.cn %K internet use %K cognitive decline %K China %K fixed-effects analysis %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Given that cognitive decline lacks effective treatment options and has severe implications for healthy aging, internet use may achieve nonpharmacological relief of cognitive decline through cognitive stimulation and social engagement. Objective: This longitudinal study aimed to investigate the relationship between the diversity, frequency, and type of internet use and cognitive decline, and to provide theoretical support and suggestions for mitigating cognitive decline in middle-aged and older adults. Methods: Data were obtained from a total of 10,532 survey respondents from the China Family Panel Studies database from wave 3 (2014) and wave 5 (2018) of the survey. Cognitive function was measured using vocabulary tests, and internet use was categorized into five aspects: study, work, socializing, entertainment, and commercial-related activities. Associations between the diversity, frequency, and type of internet use and cognitive decline were estimated by controlling for demographic variables and health status risk factors through fixed-effects models. Results: After controlling for demographic and health status risk factors, the type and frequency of internet use were found to be associated with cognitive functioning during the subsequent 4-year period, and different types of internet use had different effects on cognitive decline. Frequency of internet use of at least once a week for study (β=0.620, 95% CI 0.061 to 1.180; P=.04), work (β=0.896, 95% CI 0.271 to 1.520; P=.01), and entertainment (β=0.385, 95% CI –0.008 to 0.778; P=.06), as well as less than once a week for social purposes (β=0.860, 95% CI 0.074 to 1.650; P=.06), were associated with better cognitive function. Frequency of internet use of less than once a week for commercial-related activities (β=–0.906, 95% CI –1.480 to –0.337; P=.005) was associated with poorer cognitive function. Using the internet for more than one type of activity (β=0.458, 95% CI 0.065 to 0.850; P=.03) and at least once a week (β=0.436, 95% CI 0.066 to 0.806; P=.02) was associated with better cognitive function. Conclusions: This study shows that breadth and depth of internet use are positively associated with cognitive function and that different types of internet use have different roles in cognitive decline. The importance of the internet as a nonpharmacological intervention pathway for cognitive decline is emphasized. Future research could explore specific mechanisms of influence. %M 35072642 %R 10.2196/25760 %U https://www.jmir.org/2022/1/e25760 %U https://doi.org/10.2196/25760 %U http://www.ncbi.nlm.nih.gov/pubmed/35072642 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e30388 %T Investigation of Carers’ Perspectives of Dementia Misconceptions on Twitter: Focus Group Study %A Hudson,Georgie %A Jansli,Sonja M %A Erturk,Sinan %A Morris,Daniel %A Odoi,Clarissa M %A Clayton-Turner,Angela %A Bray,Vanessa %A Yourston,Gill %A Clouden,Doreen %A Proudfoot,David %A Cornwall,Andrew %A Waldron,Claire %A Wykes,Til %A Jilka,Sagar %+ Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 2.13 Henry Wellcome Building, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 7708715627, sagar.jilka@kcl.ac.uk %K patient and public involvement %K dementia %K co-production %K misconceptions %K stigma %K Twitter %K social media %K Alzheimer’s Disease %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Dementia misconceptions on social media are common, with negative effects on people with the condition, their carers, and those who know them. This study codeveloped a thematic framework with carers to understand the forms these misconceptions take on Twitter. Objective: The aim of this study is to identify and analyze types of dementia conversations on Twitter using participatory methods. Methods: A total of 3 focus groups with dementia carers were held to develop a framework of dementia misconceptions based on their experiences. Dementia-related tweets were collected from Twitter’s official application programming interface using neutral and negative search terms defined by the literature and by carers (N=48,211). A sample of these tweets was selected with equal numbers of neutral and negative words (n=1497), which was validated in individual ratings by carers. We then used the framework to analyze, in detail, a sample of carer-rated negative tweets (n=863). Results: A total of 25.94% (12,507/48,211) of our tweet corpus contained negative search terms about dementia. The carers’ framework had 3 negative and 3 neutral categories. Our thematic analysis of carer-rated negative tweets found 9 themes, including the use of weaponizing language to insult politicians (469/863, 54.3%), using dehumanizing or outdated words or statements about members of the public (n=143, 16.6%), unfounded claims about the cures or causes of dementia (n=11, 1.3%), or providing armchair diagnoses of dementia (n=21, 2.4%). Conclusions: This is the first study to use participatory methods to develop a framework that identifies dementia misconceptions on Twitter. We show that misconceptions and stigmatizing language are not rare. They manifest through minimizing and underestimating language. Web-based campaigns aiming to reduce discrimination and stigma about dementia could target those who use negative vocabulary and reduce the misconceptions that are being propagated, thus improving general awareness. %M 35072637 %R 10.2196/30388 %U https://aging.jmir.org/2022/1/e30388 %U https://doi.org/10.2196/30388 %U http://www.ncbi.nlm.nih.gov/pubmed/35072637 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29987 %T Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic %A Muñoz,John %A Mehrabi,Samira %A Li,Yirou %A Basharat,Aysha %A Middleton,Laura E %A Cao,Shi %A Barnett-Cowan,Michael %A Boger,Jennifer %+ Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, john.munoz.hci@uwaterloo.ca %K virtual reality %K exergames %K persons living with dementia %K physical activity %K head mounted displays %K participatory design %K co-development %K gaming %K older adults %K elderly %K design %K dementia %K VR %K user-centered %K physical activity %K exercise %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. %M 35044320 %R 10.2196/29987 %U https://games.jmir.org/2022/1/e29987 %U https://doi.org/10.2196/29987 %U http://www.ncbi.nlm.nih.gov/pubmed/35044320 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e24483 %T Co-design of a Smartphone App for People Living With Dementia by Applying Agile, Iterative Co-design Principles: Development and Usability Study %A Fox,Sarah %A Brown,Laura J E %A Antrobus,Steven %A Brough,David %A Drake,Richard J %A Jury,Francine %A Leroi,Iracema %A Parry-Jones,Adrian R %A Machin,Matthew %+ Division of Informatics, Imaging & Data Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)7917 520637, matthew.machin@manchester.ac.uk %K agile %K dementia %K co-design %K cognition %K mHealth %K patient public involvement %K software development %K mobile phone %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of involving those with lived experience in the design and development of health technology are well recognized, and the reporting of co-design best practices has increased over the past decade. However, it is important to recognize that the methods and protocols behind patient and public involvement and co-design vary depending on the patient population accessed. This is especially important when considering individuals living with cognitive impairments, such as dementia, who are likely to have needs and experiences unique to their cognitive capabilities. We worked alongside individuals living with dementia and their care partners to co-design a mobile health app. This app aimed to address a gap in our knowledge of how cognition fluctuates over short, microlongitudinal timescales. The app requires users to interact with built-in memory tests multiple times per day, meaning that co-designing a platform that is easy to use, accessible, and appealing is particularly important. Here, we discuss our use of Agile methodology to enable those living with dementia and their care partners to be actively involved in the co-design of a mobile health app. Objective: The aim of this study is to explore the benefits of co-design in the development of smartphone apps. Here, we share our co-design methodology and reflections on how this benefited the completed product. Methods: Our app was developed using Agile methodology, which allowed for patient and care partner input to be incorporated iteratively throughout the design and development process. Our co-design approach comprised 3 core elements, aligned with the values of patient co-design and adapted to meaningfully involve those living with cognitive impairments: end-user representation at research and software development meetings via a patient proxy; equal decision-making power for all stakeholders based on their expertise; and continuous user consultation, user-testing, and feedback. Results: This co-design approach resulted in multiple patient and care partner–led software alterations, which, without consultation, would not have been anticipated by the research team. This included 13 software design alterations, renaming of the product, and removal of a cognitive test deemed to be too challenging for the target demographic. Conclusions: We found patient and care partner input to be critical throughout the development process for early identification of design and usability issues and for identifying solutions not previously considered by our research team. As issues addressed in early co-design workshops did not reoccur subsequently, we believe this process made our product more user-friendly and acceptable, and we will formally test this assumption through future pilot-testing. %M 35029539 %R 10.2196/24483 %U https://mhealth.jmir.org/2022/1/e24483 %U https://doi.org/10.2196/24483 %U http://www.ncbi.nlm.nih.gov/pubmed/35029539 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31664 %T Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model %A Lee,Jaegyeong %A Lim,Jung Min %+ Department of Pharmacology, Yonsei University College of Medicine, Avison Biomedical Research Center, Room 318, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 0925, dreamist88@gmail.com %K cognitive training apps %K dementia knowledge %K health belief model %K middle-aged %K logistic regression analysis %K dementia %K Alzheimer disease %K cognition %K mobile apps %K health apps %D 2022 %7 14.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence and economic burden of dementia are increasing dramatically. Using information communication technology to improve cognitive functions is proven to be effective and holds the potential to serve as a new and efficient method for the prevention of dementia. Objective: The aim of this study was to identify factors associated with the experience of mobile apps for cognitive training in middle-aged adults. We evaluated the relationships between the experience of cognitive training apps and structural variables using an extended health belief model. Methods: An online survey was conducted on South Korean participants aged 40 to 64 years (N=320). General characteristics and dementia knowledge were measured along with the health belief model constructs. Statistical analysis and logistic regression analysis were performed. Results: Higher dementia knowledge (odds ratio [OR] 1.164, P=.02), higher perceived benefit (OR 1.373, P<.001), female gender (OR 0.499, P=.04), and family history of dementia (OR 1.933, P=.04) were significantly associated with the experience of cognitive training apps for the prevention of dementia. Conclusions: This study may serve as a theoretical basis for the development of intervention strategies to increase the use of cognitive training apps for the prevention of dementia. %M 35029540 %R 10.2196/31664 %U https://www.jmir.org/2022/1/e31664 %U https://doi.org/10.2196/31664 %U http://www.ncbi.nlm.nih.gov/pubmed/35029540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28113 %T Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review %A Stargatt,Jennifer %A Bhar,Sunil %A Bhowmik,Jahar %A Al Mahmud,Abdullah %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John St, Hawthorn, 3122, Australia, 61 432489829, jstargatt@swin.edu.au %K digital storytelling %K mental health %K aging %K dementia %K reminiscence %K memory %K systematic review %K older adults %D 2022 %7 12.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Digital storytelling is an emerging tool for sharing and recording lived experiences and may have the potential to support well-being but is yet to be systematically reviewed for use among older adults. Objective: The aim of this review is to examine the methods for creating digital stories, the health-related outcomes associated with creating digital stories, and the potential for implementing digital storytelling with older adults. Methods: We systematically searched electronic databases to identify articles published in English that reported on at least one health-related outcome of digital storytelling for participants aged ≥60 years. Data were extracted and synthesized using qualitative content analysis and summarized in tables. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 8 studies were included in the review. Participants were primarily community-dwelling older adults living with dementia, involving family caregivers and professional care staff. Studies have taken various approaches to digital storytelling and reported diverse benefits associated with digital storytelling, including improvements in mood, memory, social engagement, and quality of relationships. Although the potential for implementation was not widely examined, some studies have presented evidence for acceptability and feasibility. Generally, studies were of high quality, despite the absence of comparator groups and confounder analyses. Conclusions: The evidence reviewed suggests that despite the various approaches taken, digital storytelling shows promise as an effective approach for supporting well-being in older adults. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019145922; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145922 International Registered Report Identifier (IRRID): RR2-10.2196/15512 %M 35019845 %R 10.2196/28113 %U https://www.jmir.org/2022/1/e28113 %U https://doi.org/10.2196/28113 %U http://www.ncbi.nlm.nih.gov/pubmed/35019845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25748 %T Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study %A Hsu,Wan-Yu %A Rowles,William %A Anguera,Joaquin A %A Anderson,Annika %A Younger,Jessica W %A Friedman,Samuel %A Gazzaley,Adam %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 595 2795, Riley.Bove@ucsf.edu %K cognition %K digital health %K mHealth %K multiple sclerosis %K cognitive assessment %D 2021 %7 30.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective: To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods: In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results: Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions: These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618 %M 34967751 %R 10.2196/25748 %U https://www.jmir.org/2021/12/e25748 %U https://doi.org/10.2196/25748 %U http://www.ncbi.nlm.nih.gov/pubmed/34967751 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e19543 %T Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study %A Davies,Karen %A Cheraghi-Sohi,Sudeh %A Ong,Bie Nio %A Cheraghi-Sohi,Sudeh %A Perryman,Katherine %A Sanders,Caroline %+ National Institute for Health Research Patient Safety Research Translation Centre, University of Manchester, Oxford Rd, Manchester, United Kingdom, 44 1612767665, sudeh.cheraghi-sohi@manchester.ac.uk %K design research %K co-design %K dementia %K mobile app %K communication %K safety %K mobile phone %D 2021 %7 20.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice—championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 %M 34932011 %R 10.2196/19543 %U https://www.researchprotocols.org/2021/12/e19543 %U https://doi.org/10.2196/19543 %U http://www.ncbi.nlm.nih.gov/pubmed/34932011 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30353 %T Dementia Caregiver Experiences and Recommendations for Using the Behavioral and Environmental Sensing and Intervention System at Home: Usability and Acceptability Study %A Anderson,Martha Smith %A Bankole,Azziza %A Homdee,Nutta %A Mitchell,Brook A %A Byfield,Grace E %A Lach,John %+ Department of Health Care Innovation and Implementation Science, Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA, 24016, United States, 1 540 520 2761, msaconsulting@mail.com %K dementia %K agitation %K sensors %K smart health %K wearable technology %K just-in-time notifications %K caregiver %K dyad %K home-based %K qualitative %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Caregiver burden associated with dementia-related agitation is one of the most common reasons for a community-dwelling person living with dementia to transition to a care facility. The Behavioral and Environmental Sensing and Intervention (BESI) for the Dementia Caregiver Empowerment system uses sensing technology, smartwatches, tablets, and data analytics to detect and predict agitation in persons living with dementia and to provide just-in-time notifications and dyad-specific intervention recommendations to caregivers. The BESI system has shown that there is a valid relationship between dementia-related agitation and environmental factors and that caregivers prefer a home-based monitoring system. Objective: The aim of this study is to obtain input from caregivers of persons living with dementia on the value, usability, and acceptability of the BESI system in the home setting and obtain their insights and recommendations for the next stage of system development. Methods: A descriptive qualitative design with thematic analysis was used to analyze 10 semistructured interviews with caregivers. The interviews comprised 16 questions, with an 80% (128/160) response rate. Results: Postdeployment caregiver feedback about the BESI system and the overall experience were generally positive. Caregivers acknowledged the acceptability of the system by noting the ease of use and saw the system as a fit for them. Functionality issues such as timeliness in agitation notification and simplicity in the selection of agitation descriptors on the tablet interface were identified, and caregivers indicated a desire for more word options to describe agitation behaviors. Agitation intervention suggestions were well received by the caregivers, and the resulting decrease in the number and severity of agitation events helped confirm that the BESI system has good value and acceptability. Thematic analysis suggested several subjective experiences and yielded the themes of usefulness and helpfulness. Conclusions: This study determined preferences for assessing caregiver strain and burden, explored caregiver acceptance of the technology system (in-home sensors, actigraph or smart watch technology, and tablet devices), discerned caregiver insights on the burden and stress of caring for persons living with dementia experiencing agitation in dementia, and solicited caregiver input and recommendations for system changes. The themes of usefulness and helpfulness support the use of caregiver knowledge and experience to inform further development of the technology. %M 34874886 %R 10.2196/30353 %U https://aging.jmir.org/2021/4/e30353 %U https://doi.org/10.2196/30353 %U http://www.ncbi.nlm.nih.gov/pubmed/34874886 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30919 %T A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study %A Yan,Mingli %A Yin,Huiru %A Meng,Qiuyan %A Wang,Shuo %A Ding,Yiwen %A Li,Guichen %A Wang,Chunyan %A Chen,Li %+ School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130021, China, 86 043185619366, chen_care@126.com %K virtual reality %K mild cognitive impairment %K dementia %K ambient intelligence %K digital health %K elderly population %K aging %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mild cognitive impairment (MCI) is often a precursor of dementia, and patients with MCI develop dementia at a higher rate than healthy older adults. Early detection of cognitive decline at the MCI stage supports better planning of care and interventions. At present, the use of virtual reality (VR) in screening for MCI in older adults is promising, but there is little evidence regarding the use of virtual supermarkets to screen for MCI. Objective: The objectives of this study are to validate a VR game–based test, namely, the Virtual Supermarket Program (VSP), for differentiating patients with MCI and healthy controls and to identify cutoff scores for different age levels. Methods: Subjects were recruited from several nursing homes and communities in Changchun, China. They were divided into a healthy control group (n=64) and an MCI group (n=62). All subjects were administered the VSP and a series of neuropsychological examinations. The study determined the optimal cutoff, discriminating validity, concurrent validity, and retest reliability of the VSP. We used the area under the receiver operating characteristic curve (AUC) to evaluate the discriminating validity and obtain the optimal cutoff values. Pearson correlation analysis and the intraclass correlation coefficient were used to evaluate the concurrent validity and retest reliability, respectively. Results: A cutoff score of 46.4 was optimal for the entire sample, yielding a sensitivity of 85.9% and specificity of 79.0% for differentiating individuals with MCI and healthy controls, and the AUC was 0.870 (95% CI 0.799-0.924). The median index of VSP score was 51.1 (range 42.6-60.0). There was a moderate positive correlation between the VSP total score and Mini-Mental State Examination score (r=0.429, P<.001). There was a strong positive correlation between VSP total score and Montreal Cognitive Assessment score (r=0.645, P<.001). The retest reliability of the VSP was feasible (r=0.588, P=.048). Conclusions: The VSP is interesting and feasible for subjects. It shows high sensitivity and specificity for the identification of MCI in older adults, which makes it a promising screening method. The VSP may be generalized to older adults in other countries, although some cultural adaptation may be necessary. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040074; https://www.chictr.org.cn/showprojen.aspx?proj=64639 %M 34870610 %R 10.2196/30919 %U https://games.jmir.org/2021/4/e30919 %U https://doi.org/10.2196/30919 %U http://www.ncbi.nlm.nih.gov/pubmed/34870610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31053 %T Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study %A van Gils,Aniek M %A Visser,Leonie NC %A Hendriksen,Heleen MA %A Georges,Jean %A Muller,Majon %A Bouwman,Femke H %A van der Flier,Wiesje M %A Rhodius-Meester,Hanneke FM %+ Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440685, a.vangils@amsterdamumc.nl %K artificial intelligence %K clinical decision support systems %K dementia %K diagnostic testing %K diagnosis %K prognosis %K communication %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis. Objective: This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners. Methods: Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer’s Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer’s Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54% female) participated in this survey. Results: Most clinicians reported a willingness to use diagnostic (88/109, 80.7%) and prognostic (83/109, 76.1%) computer tools. User-friendliness (71/109, 65.1%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72%) and prognosis (73/96, 76%). In addition, most of them thought favorably regarding the possibility of using the tools themselves. Conclusions: This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity. %M 34870612 %R 10.2196/31053 %U https://formative.jmir.org/2021/12/e31053 %U https://doi.org/10.2196/31053 %U http://www.ncbi.nlm.nih.gov/pubmed/34870612 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e28652 %T An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study %A Goodridge,Donna %A Reis,Nathan %A Neiser,Jenna %A Haubrich,Tim %A Westberg,Bev %A Erickson-Lumb,Laura %A Storozinski,Jo %A Gonzales,Cesar %A Michael,Joanne %A Cammer,Allison %A Osgood,Nathaniel %+ Department of Medicine, University of Saskatchewan, Room E1216, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 2Z4, Canada, 1 3069664209, donna.goodridge@usask.ca %K virtual support programs %K caregivers %K dementia %K mindfulness %K self-compassion %K mobile health %K mobile applications %K elderly %K older adults %K usability %K feasibility %K smartphone app %K mobile phone %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety. Objective: The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program. Methods: Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37%), children (21/57, 37%), and friends or relatives (15/57, 26%) of persons with dementia, of whom 29 (51%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, “How are you feeling today?” Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I. Results: Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource. Conclusions: Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion. %M 34842530 %R 10.2196/28652 %U https://aging.jmir.org/2021/4/e28652 %U https://doi.org/10.2196/28652 %U http://www.ncbi.nlm.nih.gov/pubmed/34842530 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30249 %T Examining the Academic Trends in Neuropsychological Tests for Executive Functions Using Virtual Reality: Systematic Literature Review %A Kim,Euisung %A Han,Jieun %A Choi,Hojin %A Prié,Yannick %A Vigier,Toinon %A Bulteau,Samuel %A Kwon,Gyu Hyun %+ Graduate School of Technology and Innovation Management, Hanyang University, Wangsimni-ro 222, Multidisciplinary Lecture Hall 703, Seoul, 04763, Republic of Korea, 82 222202414, ghkwon@hanyang.ac.kr %K virtual reality %K neuropsychological test %K executive function %K cognitive ability %K brain disorder %K immersive %K digital health %K cognition %K academic trends %K neurology %D 2021 %7 24.11.2021 %9 Review %J JMIR Serious Games %G English %X Background: In neuropsychology, fully immersive virtual reality (VR) has been spotlighted as a promising tool. It is considered that VR not only overcomes the existing limitation of neuropsychological tests but is also appropriate for treating executive functions (EFs) within activities of daily living (ADL) due to its high ecological validity. While fully immersive VR offers new possibilities of neuropsychological tests, there are few studies that overview the intellectual landscape and academic trends in the research related to mainly targeted EFs with fully immersive VR. Objective: The objective of this study is to get an overview of the research trends that use VR in neuropsychological tests and to analyze the research trends using fully immersive VR neuropsychological tests with experimental articles. Methods: This review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched in three web databases using keywords related to VR, EFs, and cognitive abilities. The study was conducted in two steps, keyword analysis and in-depth systematic review. In the web database search from 2000 to 2019, 1167 articles were initially collected, of which 234 articles in the eligibility phase were used to conduct keyword analysis and a total of 47 articles were included for systematic review. Results: In keyword analysis, the number of articles focused on dementia including the keywords “MCI,” “SCD,” and “dementia” were highlighted over the period, rather than other symptoms. In addition, we identified that the use of behavioral and physiological data in virtual environments (VEs) has dramatically increased in recent studies. In the systematic review, we focused on the purpose of study, assessment, treatment, and validation of usability and structure. We found that treatment studies and uncategorized studies including presence and cybersickness issues have emerged in the recent period. In addition, the target symptoms and range of participants were diversified. Conclusions: There has been a continuously increasing interest in dealing with neuropsychology by using fully immersive VR. Target cognitive abilities have been diversified, as well as target symptoms. Moreover, the concept of embodied cognition was transplanted in this research area. %M 34822341 %R 10.2196/30249 %U https://games.jmir.org/2021/4/e30249 %U https://doi.org/10.2196/30249 %U http://www.ncbi.nlm.nih.gov/pubmed/34822341 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33589 %T Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study %A Cabral,Danylo F %A Hinchman,Carrie A %A Nunez,Christina %A Rice,Jordyn %A Loewenstein,David A %A Cahalin,Lawrence P %A Rundek,Tatjana %A Pascual-Leone,Alvaro %A Gomes-Osman,Joyce %+ Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th St #609, Miami, FL, United States, 1 305 243 6732, j.gomes@miami.edu %K exercise %K neuroplasticity %K cognition %K brain health %K cardiorespiratory fitness %K cardiovascular function %K trophic factors %K telehealth %K aging adult %D 2021 %7 23.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. Objective: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. Methods: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. Results: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. Conclusions: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. Trial Registration: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528 International Registered Report Identifier (IRRID): RR1-10.2196/33589 %M 34817393 %R 10.2196/33589 %U https://www.researchprotocols.org/2021/11/e33589 %U https://doi.org/10.2196/33589 %U http://www.ncbi.nlm.nih.gov/pubmed/34817393 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27630 %T Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences %A Xiang,Xiaoling %A Kayser,Jay %A Sun,Yihang %A Himle,Joseph %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 7347636581, xiangxi@umich.edu %K internet-based cognitive behavioral therapy %K homebound older adults %K home care %K direct care workers %K depression %K qualitative study %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants’ experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants’ perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 %M 34813491 %R 10.2196/27630 %U https://aging.jmir.org/2021/4/e27630 %U https://doi.org/10.2196/27630 %U http://www.ncbi.nlm.nih.gov/pubmed/34813491 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e16824 %T Developing a Management Guide (the DemPower App) for Couples Where One Partner Has Dementia: Nonrandomized Feasibility Study %A Lasrado,Reena %A Bielsten,Therese %A Hann,Mark %A Schumm,James %A Reilly,Siobhan Theresa %A Davies,Linda %A Swarbrick,Caroline %A Dowlen,Robyn %A Keady,John %A Hellström,Ingrid %+ Social Care & Society, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613067884, reena.lasrado@manchester.ac.uk %K dementia guide %K self-management for couples with dementia %K dementia self-help %K dementia app %K dementia resource %K feasibility study %K nonrandomized study %K dementia intervention %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Promoting the health and well-being of couples where one partner has dementia is an overlooked area of care practice. Most postdiagnostic services currently lack a couple-centered approach and have a limited focus on the couple relationship. To help address this situation, we developed a tablet-based self-management guide (DemPower) focused on helping couples enhance their well-being and relationship quality. Objective: The aim of this study is to investigate the feasibility and acceptability of the DemPower app. Methods: A nonrandomized feasibility design was used to evaluate the DemPower intervention over 3 months among couples where a partner had a diagnosis of dementia. The study recruited 25 couples in the United Kingdom and 19 couples in Sweden. Outcome measures were obtained at baseline and postintervention. The study process and interventions were evaluated at various stages. Results: The study was completed by 48% (21/44) of couples where one partner had dementia, of whom 86% (18/21) of couples accessed all parts of the DemPower app. Each couple spent an average of 8 hours (SD 3.35 hours) using the app during the study period. In total, 90% (19/21) of couples reported that all sections of DemPower were useful in addressing various aspects of daily life and helped to focus on how they interacted in their relationship. Of the 4 core subjects on which the DemPower app was structured, home and neighborhood received the highest number of visits. Couples used activity sections more often than the core subject pages. The perception of DemPower’s utility varied with each couple’s lived experience of dementia, geographic location, relationship dynamics, and opportunities for social interaction. A 5.2-point increase in the dementia quality of life score for people with dementia and a marginal increase in the Mutuality scale (+1.23 points) for caregiver spouses were found. Design and navigational challenges were reported in the DemPower app. Conclusions: The findings suggest that the DemPower app is a useful resource for couples where one partner has dementia and that the implementation of the app requires the support of memory clinics to reach couples at early diagnosis. Trial Registration: ISRCTN Registry ISRCTN10122979; http://www.isrctn.com/ISRCTN10122979 %M 34783666 %R 10.2196/16824 %U https://aging.jmir.org/2021/4/e16824 %U https://doi.org/10.2196/16824 %U http://www.ncbi.nlm.nih.gov/pubmed/34783666 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33572 %T Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial %A Nguyen,Tuan Anh %A Tran,Kham %A Esterman,Adrian %A Brijnath,Bianca %A Xiao,Lily Dongxia %A Schofield,Penelope %A Bhar,Sunil %A Wickramasinghe,Nilmini %A Sinclair,Ronald %A Dang,Thu Ha %A Cullum,Sarah %A Turana,Yuda %A Hinton,Ladson %A Seeher,Katrin %A Andrade,Andre Q %A Crotty,Maria %A Kurrle,Susan %A Freel,Stefanie %A Pham,Thang %A Nguyen,Thanh Binh %A Brodaty,Henry %+ Social Gerontology Division, National Ageing Research Institute, 34-54 Poplar Road, Gate 4, Building 9, Melbourne, 3050, Australia, 61 3 8387 2305, t.nguyen@nari.edu.au %K Dementia %K informal carer %K iSupport %K virtual assistant %K digital health %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). Objective: This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Methods: Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. Results: This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). Conclusions: This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz International Registered Report Identifier (IRRID): PRR1-10.2196/33572 %M 34783660 %R 10.2196/33572 %U https://www.researchprotocols.org/2021/11/e33572 %U https://doi.org/10.2196/33572 %U http://www.ncbi.nlm.nih.gov/pubmed/34783660 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e18359 %T Dissecting Digital Card Games to Yield Digital Biomarkers for the Assessment of Mild Cognitive Impairment: Methodological Approach and Exploratory Study %A Gielis,Karsten %A Vanden Abeele,Marie-Elena %A De Croon,Robin %A Dierick,Paul %A Ferreira-Brito,Filipa %A Van Assche,Lies %A Verbert,Katrien %A Tournoy,Jos %A Vanden Abeele,Vero %+ e-Media Research Lab, Katholieke Universiteit Leuven, Andreas Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16376866, karsten.gielis@kuleuven.be %K mild cognitive impairment %K Klondike Solitaire %K card games %K generalized linear mixed effects analysis %K expert study %K monitoring %K screening %K cognition %K dementia %K older adults %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mild cognitive impairment (MCI), the intermediate cognitive status between normal cognitive decline and pathological decline, is an important clinical construct for signaling possible prodromes of dementia. However, this condition is underdiagnosed. To assist monitoring and screening, digital biomarkers derived from commercial off-the-shelf video games may be of interest. These games maintain player engagement over a longer period of time and support longitudinal measurements of cognitive performance. Objective: This paper aims to explore how the player actions of Klondike Solitaire relate to cognitive functions and to what extent the digital biomarkers derived from these player actions are indicative of MCI. Methods: First, 11 experts in the domain of cognitive impairments were asked to correlate 21 player actions to 11 cognitive functions. Expert agreement was verified through intraclass correlation, based on a 2-way, fully crossed design with type consistency. On the basis of these player actions, 23 potential digital biomarkers of performance for Klondike Solitaire were defined. Next, 23 healthy participants and 23 participants living with MCI were asked to play 3 rounds of Klondike Solitaire, which took 17 minutes on average to complete. A generalized linear mixed model analysis was conducted to explore the differences in digital biomarkers between the healthy participants and those living with MCI, while controlling for age, tablet experience, and Klondike Solitaire experience. Results: All intraclass correlations for player actions and cognitive functions scored higher than 0.75, indicating good to excellent reliability. Furthermore, all player actions had, according to the experts, at least one cognitive function that was on average moderately to strongly correlated to a cognitive function. Of the 23 potential digital biomarkers, 12 (52%) were revealed by the generalized linear mixed model analysis to have sizeable effects and significance levels. The analysis indicates sensitivity of the derived digital biomarkers to MCI. Conclusions: Commercial off-the-shelf games such as digital card games show potential as a complementary tool for screening and monitoring cognition. Trial Registration: ClinicalTrials.gov NCT02971124; https://clinicaltrials.gov/ct2/show/NCT02971124 %M 34734825 %R 10.2196/18359 %U https://games.jmir.org/2021/4/e18359 %U https://doi.org/10.2196/18359 %U http://www.ncbi.nlm.nih.gov/pubmed/34734825 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31649 %T Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study %A Reichold,Michael %A Heß,Miriam %A Kolominsky-Rabas,Peter %A Gräßel,Elmar %A Prokosch,Hans-Ulrich %+ Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, Erlangen, 91058, Germany, 49 91318526720, michael.reichold@fau.de %K dementia %K usability %K evaluation %K mobile device %K registry %K electronic data collection %K offline %K mobile app %K digital health %K usability testing %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project “Digital Dementia Registry Bavaria (digiDEM Bayern),” interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the “Thinking Aloud” method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the “Thinking Aloud” method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents “good” usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry–based research project. %M 34730543 %R 10.2196/31649 %U https://formative.jmir.org/2021/11/e31649 %U https://doi.org/10.2196/31649 %U http://www.ncbi.nlm.nih.gov/pubmed/34730543 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e30337 %T User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study %A Bradwell,Hannah Louise %A Edwards,Katie %A Shenton,Deborah %A Winnington,Rhona %A Thill,Serge %A Jones,Ray B %+ Centre for Health Technology, Faculty of Health, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 07975927341, hannah.bradwell@plymouth.ac.uk %K companion robots %K social robots %K Paro %K older adults %K dementia %K care homes %K engagement %K acceptability %K gerontology %K Joy for All %K social care %K user-centered design %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations. %M 34723825 %R 10.2196/30337 %U https://rehab.jmir.org/2021/4/e30337 %U https://doi.org/10.2196/30337 %U http://www.ncbi.nlm.nih.gov/pubmed/34723825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29001 %T Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy %A Cho,Eunhee %A Kim,Sujin %A Hwang,Sinwoo %A Kwon,Eunji %A Heo,Seok-Jae %A Lee,Jun Hong %A Ye,Byoung Seok %A Kang,Bada %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-Ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283274, bdkang@yuhs.ac %K behavioral and psychological symptoms %K dementia %K older adults %K actigraphy %K sleep %K activity %K risk factors %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. Objective: The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. Methods: A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. Results: Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. Conclusions: BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care. %M 34714244 %R 10.2196/29001 %U https://www.jmir.org/2021/10/e29001 %U https://doi.org/10.2196/29001 %U http://www.ncbi.nlm.nih.gov/pubmed/34714244 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e28165 %T Personalized Visual Mapping Assistive Technology to Improve Functional Ability in Persons With Dementia: Feasibility Cohort Study %A Kelleher,Jessica %A Zola,Stuart %A Cui,Xiangqin %A Chen,Shiyu %A Gerber,Caroline %A Parker,Monica Willis %A Davis,Crystal %A Law,Sidney %A Golden,Matthew %A Vaughan,Camille P %+ Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, 3101 Clairmont RD, Atlanta, GA, 30329, United States, 1 404 315 4100 ext 373125, jessica.kelleher@va.gov %K aging %K ageing %K impaired memory %K assistive technology %K assistive technologies %K function %K assistive devices %K cognition %K cognitive %K activities of daily living %K mobile technology %K mobile technologies %K dementia %K Alzheimer %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Mobile health (mHealth) apps using novel visual mapping assistive technology can allow users to develop personalized maps that aid people living with cognitive impairment in the recall of steps needed to independently complete activities of daily living (ADLs), such as bathing, toileting, and dressing. Objective: This study aims to determine the feasibility and preliminary impact of an mHealth assistive technology app providing guidance to aid individuals living with cognitive impairment in the recall of steps to independently complete ADLs. Methods: A total of 14 Veterans (mean age 65 SD 9.5 years; 14/14, 100% male; 10/14, 71.4% Black) and 8 non-Veterans (mean age 78, SD 10.3 years; 5/8, 62.5% male; 8/8, 100% Black) were recruited and enrolled from the Department of Veterans Affairs (VA) and non-VA cognitive care clinics. A visual mapping software program, MapHabit, was used to generate a series of personalized visual map templates focused on ADLs created within the MapHabit app. The visual maps were accessed through a tablet device. A 19-item exit questionnaire was administered to the participants to assess perceived improvement in their functional ability after using the MapHabit system for 3 months. Results: A total of 13 (93%) VA clinic participants and 8 (100%) non-VA clinic participants completed the 3-month study. Baseline cognitive testing indicated impaired to significantly impaired cognitive function. After 3 months of using the MapHabit system, VA clinic participants reported perceived improvement in social engagement (P=.01) and performance of ADLs (P=.05) compared to the baseline, whereas non-VA clinic participants reported improvements in the performance of ADLs (P=.02), mood (P=.04), social engagement (P=.02), and memory (P=.02). All study participants reported they would recommend the MapHabit system to a colleague, and 85% (11/14) of VA and 100% (8/8) of non-VA clinic participants reported a willingness to participate in a future study. Conclusions: Older VA and non-VA clinic participants with cognitive impairment were willing to use an mHealth app to assist with the completion of ADLs, and they reported positive preliminary effects. A larger study is warranted to assess the efficacy in the setting of a randomized controlled trial. %M 34269690 %R 10.2196/28165 %U https://aging.jmir.org/2021/4/e28165 %U https://doi.org/10.2196/28165 %U http://www.ncbi.nlm.nih.gov/pubmed/34269690 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30652 %T e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study %A Nakanishi,Miharu %A Yamasaki,Syudo %A Endo,Kaori %A Niimura,Junko %A Ziylan,Canan %A Bakker,Ton J E M %A Granvik,Eva %A Nägga,Katarina %A Nishida,Atsushi %+ Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, 980-8575, Japan, 81 22 717 8179, mnakanishi-tky@umin.ac.jp %K dementia %K home care services %K implementation science %K nursing homes %K web-based tool %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. Objective: The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. Methods: A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. Results: A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=–0.61, P=.69). Conclusions: The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated. %M 34543224 %R 10.2196/30652 %U https://mededu.jmir.org/2021/4/e30652 %U https://doi.org/10.2196/30652 %U http://www.ncbi.nlm.nih.gov/pubmed/34543224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27267 %T Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies %A Ehn,Maria %A Richardson,Matt X %A Landerdahl Stridsberg,Sara %A Redekop,Ken %A Wamala-Andersson,Sarah %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, SE-721 23, Sweden, 46 21 107093, maria.ehn@mdh.se %K GPS %K older adults %K dementia %K evidence %K digital health %K NICE %K mobile phone %D 2021 %7 11.10.2021 %9 Review %J J Med Internet Res %G English %X Background: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non–GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research. %M 34633291 %R 10.2196/27267 %U https://www.jmir.org/2021/10/e27267 %U https://doi.org/10.2196/27267 %U http://www.ncbi.nlm.nih.gov/pubmed/34633291 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e30841 %T Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review %A Bastoni,Sofia %A Wrede,Christian %A da Silva,Marcia Cristina %A Sanderman,Robbert %A Gaggioli,Andrea %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %+ Department of Psychology, Health & Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534895284, s.bastoni@utwente.nl %K eHealth %K assistive technologies %K dementia %K informal care %K home care %K implementation %D 2021 %7 8.10.2021 %9 Review %J JMIR Aging %G English %X Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used “by informal caregivers,” “by people with dementia,” and “with people with dementia.” Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. %M 34623314 %R 10.2196/30841 %U https://aging.jmir.org/2021/4/e30841 %U https://doi.org/10.2196/30841 %U http://www.ncbi.nlm.nih.gov/pubmed/34623314 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30990 %T Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial %A Betz,Marian E %A Polzer,Evan %A Nearing,Kathryn %A Knoepke,Christopher E %A Johnson,Rachel L %A Meador,Lauren %A Matlock,Daniel D %+ Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, B-215, Aurora, CO, 80045, United States, 1 7208486777, marian.betz@ucdenver.edu %K dementia %K cognitive impairment %K firearm %K decision aid %K caregivers %K safety %K feasibility %K pilot trial %K Alzheimer disease %K caregiver support %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access. Objective: We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers. Methods: SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire. Results: Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases. Conclusions: SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy. %M 34550082 %R 10.2196/30990 %U https://formative.jmir.org/2021/9/e30990 %U https://doi.org/10.2196/30990 %U http://www.ncbi.nlm.nih.gov/pubmed/34550082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29210 %T The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial %A Saredakis,Dimitrios %A Keage,Hannah AD %A Corlis,Megan %A Ghezzi,Erica S %A Loffler,Helen %A Loetscher,Tobias %+ UniSA Justice & Society, University of South Australia, St Bernards Road, Magill, Adelaide, South Australia, 5072, Australia, 61 8 8302 4083, dimitrios.saredakis@mymail.unisa.edu.au %K reminiscence %K head-mounted display %K apathy %K cognitive aging %K dementia %K residential facilities %K virtual reality %D 2021 %7 20.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. Objective: This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. Methods: In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. Results: Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=−2.24, SE 1.89; t40=−1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=−0.26, SE 1.66; t40=−0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. Conclusions: Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046030 %M 34542418 %R 10.2196/29210 %U https://www.jmir.org/2021/9/e29210 %U https://doi.org/10.2196/29210 %U http://www.ncbi.nlm.nih.gov/pubmed/34542418 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27926 %T Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study %A Mendez,Kyra Jennifer Waligora %A Budhathoki,Chakra %A Labrique,Alain Bernard %A Sadak,Tatiana %A Tanner,Elizabeth K %A Han,Hae Ra %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 929 4327, kwaligo1@jhu.edu %K mHealth applications %K mobile health %K intention to adopt mHealth applications %K dementia caregivers %K family caregiving %K chronic disease self-management %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective: The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods: We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results: Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions: When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management. %M 34463637 %R 10.2196/27926 %U https://mhealth.jmir.org/2021/8/e27926 %U https://doi.org/10.2196/27926 %U http://www.ncbi.nlm.nih.gov/pubmed/34463637 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e29031 %T Using Living Labs to Explore Needs and Solutions for Older Adults With Dementia: Scoping Review %A Verloo,Henk %A Lorette,Adrien %A Rosselet Amoussou,Joëlle %A Gillès de Pélichy,Estelle %A Matos Queirós,Alcina %A von Gunten,Armin %A Perruchoud,Elodie %+ School of Health Sciences HES-SO Valais and Department of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, Sion, 1950, Switzerland, 41 78 769 8990, henk.verloo@hevs.ch %K living lab %K aged %K dementia %K cognitive dysfunction %K long-term care %K primary health care %K technology %K mobile phone %D 2021 %7 19.8.2021 %9 Review %J JMIR Aging %G English %X Background: Numerous living labs have established a new approach for studying the health, independent living, and well-being of older adults with dementia. Living labs interact with a broad set of stakeholders, including students, academic institutions, private companies, health care organizations, and patient representative bodies and even with other living labs. Hence, it is crucial to identify the types of cocreations that should be attempted and how they can be facilitated through living labs. Objective: This study aims to scope publications that examine all types of living lab activities, exploring the needs and expectations of older adults with dementia and seeking solutions, whether they live in the community or long-term health care facilities (LTHFs). Methods: This scoping review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations for the extension of scoping reviews. We searched six bibliographic databases for publications up to March 2020, and a forward-backward citation chasing was performed. Additional searches were conducted using Google Scholar. The quality of the selected papers was assessed. Results: Of the 5609 articles identified, we read 58 (1.03%) articles and retained 12 (0.21%) articles for inclusion and final analysis. All 12 articles presented an innovative product, developed in 4 main living labs, to assist older adults with cognitive disorders or dementia living in the community or LTHFs. The objectives of these studies were to optimize health, quality of life, independent living, home care, and safety of older adults with cognitive disorders or dementia, as well as to support professional and family caregivers or reduce their burdens. The overall methodological quality of the studies ranged from poor to moderate. Conclusions: This scoping review identified several living labs playing a pivotal role in research aimed at older adults with dementia living in the community or LTHFs. However, it also revealed that living labs should conduct more better-quality interventional research to prove the effectiveness of their technological products or service solutions. International Registered Report Identifier (IRRID): RR2-10.2147/SHTT.S233130 %M 34420916 %R 10.2196/29031 %U https://aging.jmir.org/2021/3/e29031 %U https://doi.org/10.2196/29031 %U http://www.ncbi.nlm.nih.gov/pubmed/34420916 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e27047 %T Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach %A Tiersen,Federico %A Batey,Philippa %A Harrison,Matthew J C %A Naar,Lenny %A Serban,Alina-Irina %A Daniels,Sarah J C %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, 25 Exhibition Road, South Kensington, London, SW7 2DB, United Kingdom, 44 (0)20 7594 8888, federico.tiersen16@imperial.ac.uk %K assistive technology %K independent living %K internet of things %K remote monitoring %K dementia %K human centered design %K user-centered design %K patient-centered care %K smart home %K digital health %D 2021 %7 11.8.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users’ safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient–caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. %M 34383672 %R 10.2196/27047 %U https://aging.jmir.org/2021/3/e27047 %U https://doi.org/10.2196/27047 %U http://www.ncbi.nlm.nih.gov/pubmed/34383672 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31183 %T Repeated Transcranial Magnetic Stimulation for Improving Cognition in Alzheimer Disease: Protocol for an Interim Analysis of a Randomized Controlled Trial %A Moussavi,Zahra %A Koski,Lisa %A Fitzgerald,Paul B %A Millikin,Colleen %A Lithgow,Brian %A Jafari-Jozani,Mohammad %A Wang,Xikui %+ Biomedical Engineering Program, Faculty of Engineering, University of Manitoba, 75 Chancellor Circle, Winnipeg, MB, R3T5V6, Canada, 1 204 474 7023, Zahra.Moussavi@umanitoba.ca %K interim analysis, treatment efficacy, repetitive transcranial magnetic stimulation %K Alzheimer disease %K double blind %K treatment %K placebo controlled %K randomized %D 2021 %7 9.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many clinical trials investigating treatment efficacy require an interim analysis. Recently we have been running a large, multisite, randomized, placebo-controlled, double-blind clinical trial investigating the effect of repetitive transcranial magnetic stimulation (rTMS) treatment for improving or stabilizing the cognition of patients diagnosed with Alzheimer disease. Objective: The objectives of this paper are to report on recruitment, adherence, and adverse events (AEs) to date, and to describe in detail the protocol for interim analysis of the clinical trial data. The protocol will investigate whether the trial is likely to reach its objectives if continued to the planned maximum sample size. Methods: The specific requirements of the analytic protocol are to (1) ensure the double-blind nature of the data while doing the analysis, (2) estimate the predictive probabilities of success (PPoSs), (3) estimate the numbers needed to treat, (4) re-estimate the initial required sample size. The initial estimate of sample size was 208. The interim analysis will be based on 150 patients who will be enrolled in the study and finish at least 8 weeks of the study. Our protocol for interim analysis, at the very first stage, is to determine the response rate for each participant to the treatment (either sham or active), while ensuring the double-blind nature of the data. The blinded data will be analyzed by a statistician to investigate the treatment efficacy. We will use Bayesian PPoS to predict the success rate and determine whether the study should continue. Results: The enrollment has been slowed significantly due to the COVID-19 pandemic and lockdown. Nevertheless, so far 133 participants have been enrolled, while 22 of these have been withdrawn or dropped out for various reasons. In general, rTMS has been found tolerable with no serious AE. Only 2 patients dropped out of the study due to their intolerability to rTMS pulses. Conclusions: Overall, the study with the same protocol is going as expected with no serious AE or any major protocol deviation. Trial Registration: ClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815 International Registered Report Identifier (IRRID): DERR1-10.2196/31183 %M 34383681 %R 10.2196/31183 %U https://www.researchprotocols.org/2021/8/e31183 %U https://doi.org/10.2196/31183 %U http://www.ncbi.nlm.nih.gov/pubmed/34383681 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e28400 %T Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick Yiu Cho %A Liu,Justina Yat Wa %A Fong,Kenneth Nai Kuen %A Qin,Jing %A Leung,Philip Kwok-Yuen %A Sin,Olive Suk Kan %A Hon,Pik Yuen %A Suen,Lydia W %A Tse,Man-Kei %A Lai,Claudia KY %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, GH502, Hung Hom, Kowloon, Hong Kong, , China (Hong Kong), 852 2766 6546, rick.kwan@polyu.edu.hk %K virtual reality %K motor-cognitive training %K cognitive frailty %K game %K feasibility %K VR %K training %K older adults %K frail %K pilot study %K randomized controlled trial %D 2021 %7 6.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments. Objective: We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty. Methods: A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed. Results: Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=–2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=–1.19, P=.24). The reduction in physical frailty in the intervention group (Z=–1.73, P=.08) was similar to that in the control group (Z=–1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=–0.16, P=.11) and greater in the control group (Z=–2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group. Conclusions: This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty. Trial Registration: ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216 %M 34383662 %R 10.2196/28400 %U https://games.jmir.org/2021/3/e28400 %U https://doi.org/10.2196/28400 %U http://www.ncbi.nlm.nih.gov/pubmed/34383662 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e29021 %T Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study %A Niculescu,Iulia %A Quirt,Hannah %A Arora,Twinkle %A Borsook,Terry %A Green,Robin %A Ford,Brett %A Iaboni,Andrea %+ KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada, 1 (416) 597 3422 ext 3027, andrea.iaboni@uhn.ca %K dementia %K depression %K ecological momentary assessment %K tool performance %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity. Objective: This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia. Methods: A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data. Results: Overall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants’ self-reports. Several items were associated with and able to predict depression. Conclusions: The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms. %M 34346884 %R 10.2196/29021 %U https://aging.jmir.org/2021/3/e29021 %U https://doi.org/10.2196/29021 %U http://www.ncbi.nlm.nih.gov/pubmed/34346884 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e30514 %T A Randomized Controlled Trial Investigating the Feasibility of a Low-Intensity Psychological Intervention for Fear of Memory Loss and Quality of Life in Older Adults: Protocol for the Reducing Fear and Avoidance of Memory Loss (REFRAME) Study %A O'Loughlin,Patricia %A Pavithra,Pavithra %A Regan,John %A Bennett,Marc %A Knight,Rachel %A Lenaert,Bert %A Marquez,Melissa %A Taddeo,Michelle %A Griffith,James %A Shapiro,Rita %A Farina,Francesca %+ Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Room 3.05 Lloyd Building, Dublin 2, D02 PN40, Ireland, 353 1 896 8484, farinaf@tcd.ie %K fear %K memory loss %K dementia %K older adults %K mindfulness %K behavioral activation %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective: We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods: Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results: Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions: Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration: ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID): PRR1-10.2196/30514 %M 34328428 %R 10.2196/30514 %U https://www.researchprotocols.org/2021/7/e30514 %U https://doi.org/10.2196/30514 %U http://www.ncbi.nlm.nih.gov/pubmed/34328428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26551 %T Exploring the Role of Web-Based Interventions in the Self-management of Dementia: Systematic Review and Narrative Synthesis %A Lee,Abigail Rebecca %A Gerritzen,Esther Vera %A McDermott,Orii %A Orrell,Martin %+ Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, United Kingdom, 44 7890 021703, abigail.lee1@nottingham.ac.uk %K systematic review %K narrative synthesis %K dementia %K web %K app %K online %K mobile phone %K self-management %D 2021 %7 26.7.2021 %9 Review %J J Med Internet Res %G English %X Background: The increasing prevalence of dementia has promoted a move toward equipping people with the skills required for greater self-management of the condition to enable a better quality of life. Self-management encompasses numerous skills, such as goal setting and decision making, which aim to improve an individual’s physical and mental well-being when they live with long-term health conditions. Effective self-management may lead to increased well-being and quality of life. Reviews of web-based and app-based interventions have suggested that they have the potential to provide self-management support for people living with a range of conditions, including dementia. Objective: The aim of this review is to explore the existing use of web-based or app-based interventions that facilitate or support self-management in dementia and discuss their effectiveness in promoting self-management and independence. Methods: A total of 5 electronic databases were systematically searched for relevant articles published between January 2010 and March 2020. Included studies were appraised using the Downs and Black checklist and the Critical Appraisal Skills Program qualitative research checklist. A narrative synthesis framework was applied using tables and conceptual mapping to explore the relationships within and among studies. Results: A total of 2561 articles were identified from the initial search, of which 11 (0.43%) met the inclusion criteria for the final analysis. These included 5 quantitative, 4 mixed methods, and 2 qualitative studies. All the included articles were of fair to high quality across the two appraisal measures. Interventions were delivered through a range of web-based and app-based technologies and targeted several self-management concepts. However, there was inconsistency regarding the domains, often affected by dementia, that were targeted by the interventions reviewed. Conclusions: Web-based and app-based interventions for dementia can be delivered through a range of means and can target different aspects of self-management. The small number of studies included in this review report positive outcomes that seem to support the use of these interventions for people living with dementia. However, there is a clear need for more high-quality research into this type of intervention delivery and for studies that use a much larger number of participants across the dementia spectrum. Future research should consider the barriers to and facilitators of intervention adoption highlighted in this review and whether interventions can encompass the physical, social, cognitive, and emotional domains affected by dementia. %M 34309575 %R 10.2196/26551 %U https://www.jmir.org/2021/7/e26551 %U https://doi.org/10.2196/26551 %U http://www.ncbi.nlm.nih.gov/pubmed/34309575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26284 %T Efficacy and Cost-effectiveness of Promotion Methods to Recruit Participants to an Online Screening Registry for Alzheimer Disease Prevention Trials: Observational Study %A Sato,Kenichiro %A Niimi,Yoshiki %A Ihara,Ryoko %A Suzuki,Kazushi %A Toda,Tatsushi %A Iwata,Atsushi %A Iwatsubo,Takeshi %+ Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, , Japan, 81 3 3815 5411, iwatsubo@m.u-tokyo.ac.jp %K online clinical study %K promotion %K advertisement %K cost-effectiveness %K Trial-Ready Cohort %K preclinical Alzheimer disease %K clinical trial %K Alzheimer %K dementia %K recruitment %D 2021 %7 22.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based screening may be suitable for identifying individuals with presymptomatic latent diseases for recruitment to clinical studies, as such people do not often visit hospitals in the presymptomatic stage. The promotion of such online screening studies is critical to their success, although it remains uncertain how the effectiveness of such promotion can differ, depending on the different promotion methods, domains of interest, or countries of implementation. Objective: The Japanese Trial-Ready Cohort (J-TRC) web study is our ongoing online screening registry to identify individuals with presymptomatic Alzheimer disease (AD), aimed at facilitating the clinical trials for AD prevention. Within the first 9 months of its 2019 launch, the J-TRC web study recruited thousands of online participants via multiple methods of promotion, including press releases, newspaper advertisements, web advertisements, or direct email invitations. Here, we aimed to quantitatively evaluate efficacy and cost-effectiveness of each of these multimodal promotion methods. Methods: We applied the vector-autoregression model to assess the degree of contribution of each type of promotion to the following target metrics: number of daily visitors to the J-TRC website, number of daily registrants to the J-TRC web study, daily rate of registration among visitors, daily rate of eligible participants among registrants, and median age of daily registrants. The average cost-effectiveness for each promotion method was also calculated using the total cost and the coefficients in the vector-autoregression model. Results: During the first 9 months of the reviewed period from October 31, 2019 to June 17, 2020, there were 48,334 website visitors and 4429 registrations (9.16% of 48,334 visitors), of which 3081 (69.56%) were eligible registrations. Initial press release reports and newspaper advertisements had a marked effect on increasing the number of daily visitors and daily registrants. Web advertisements significantly contributed to the increase in daily visitors (P<.001) but not to the daily registrants, and it also lowered the rate of registrations and the median age of daily registrants. Website visitors from the direct email invitation sent to other cognitive registries seem to have registered with the highest reliability. The calculated average cost-effectiveness for the initial press release was US $24.60 per visitor and US $96.10 per registrant, while the calculated average cost-effectiveness for the newspaper advertisements was US $28.60 per visitor and US $227.90 per registrant. Conclusions: Our multivariate time-series analysis showed that each promotion method had different features in their effect of recruiting participants to the J-TRC web study. Under the advertisement condition settings thus far, newspaper advertisements and initial press releases were the most effective promotion methods, with fair cost-effectiveness that was equivalent to earlier online studies. These results can provide important suggestions for future promotions for the recruitment of presymptomatic participants to AD clinical trials in Japan. %M 34292159 %R 10.2196/26284 %U https://www.jmir.org/2021/7/e26284 %U https://doi.org/10.2196/26284 %U http://www.ncbi.nlm.nih.gov/pubmed/34292159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25381 %T Embodied Conversational Agents for Patients With Dementia: Thematic Literature Analysis %A Rampioni,Margherita %A Stara,Vera %A Felici,Elisa %A Rossi,Lorena %A Paolini,Susy %+ Model of Care and New Technologies, IRCCS INRCA - National Institute of Health and Science on Aging, via Santa Margherita, 5, Ancona, 60124, Italy, 39 0718004614, v.stara@inrca.it %K dementia %K patient with dementia %K older adults with dementia %K embodied conversational agent %K virtual personal assistant %K virtual agent %K virtual companion %K design for older adults %K patients %K elderly %K virtual %K personal assistant %K cognitive %K cognitive impairment %D 2021 %7 16.7.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: As the world’s population rapidly ages, the number of older adults with cognitive impairment will also increase. Several studies have identified numerous complex needs of people with dementia, which assistive technologies still fail to support. Recent trends have led to an increasing focus on the use of embodied conversational agents (ECAs) as virtual entities able to interact with a person through natural and familiar verbal and nonverbal communication. The use of ECAs could improve the accessibility and acceptance of assistive technologies matching those high-level needs that are not well covered to date. Objective: The aim of this thematic literature analysis was to map current studies in the field of designing ECAs for patients with dementia in order to identify the existing research trend and possible gaps that need to be covered in the near future. The review questions in this study were as follows: (1) what research frameworks are used to study the interaction between patients with dementia and ECAs? (2) what are the findings? and (3) what are the barriers reported in these studies? Methods: Separate literature searches were conducted in PubMed, Web of Science, Scopus, and Embase databases by using specific umbrella phrases to target the population (patients with dementia) and the technology-based intervention (embodied conversational agent). Studies that met the inclusion criteria were appraised through the Mixed Methods Appraisal Tool and then discussed in a thematic analysis. Results: The search process identified 115 records from the databases and study references. After duplicates (n=45) were removed, 70 papers remained for the initial screening. A total of 7 studies were finally included in the qualitative synthesis. A thematic analysis of the reviewed studies identified major themes and subthemes: the research frameworks used to gather users’ perspectives on ECAs (theme 1), the insights shared by the 7 studies as well as the value of user involvement in the development phases and the challenge of matching the system functionalities with the users’ needs (theme 2), and the main methodological and technical problems faced by each study team (theme 3). Conclusions: Our thematic literature analysis shows that the field of ECAs is novel and poorly discussed in the scientific community and that more sophisticated study designs and proofs of efficacy of the approach are required. Therefore, by analyzing the main topic of the narrative review, this study underscores the challenge of synchronizing and harmonizing knowledge, efforts, and challenges in the dementia care field and its person-centered paradigm through the user-centered design approach. Enabling strict collaboration between interdisciplinary research networks, medical scientists, technology developers, patients, and their formal and informal caregivers is still a great challenge in the field of technologies for older adults. %M 34269686 %R 10.2196/25381 %U https://mhealth.jmir.org/2021/7/e25381 %U https://doi.org/10.2196/25381 %U http://www.ncbi.nlm.nih.gov/pubmed/34269686 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e27156 %T Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study %A Scheibe,Madlen %A Lang,Caroline %A Druschke,Diana %A Arnold,Katrin %A Luntz,Edwin %A Schmitt,Jochen %A Holthoff-Detto,Vjera %+ Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 351 458 2815, Madlen.Scheibe@ukdd.de %K telemedicine %K aged %K multimorbidity %K dementia %K patient acceptance of health care %K health care quality, access, and evaluation %K qualitative research %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps. %M 34255664 %R 10.2196/27156 %U https://humanfactors.jmir.org/2021/3/e27156 %U https://doi.org/10.2196/27156 %U http://www.ncbi.nlm.nih.gov/pubmed/34255664 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25891 %T Usability and Acceptance of the Embodied Conversational Agent Anne by People With Dementia and Their Caregivers: Exploratory Study in Home Environment Settings %A Stara,Vera %A Vera,Benjamin %A Bolliger,Daniel %A Rossi,Lorena %A Felici,Elisa %A Di Rosa,Mirko %A de Jong,Michiel %A Paolini,Susy %+ Model of Care and New Technologies, IRCCS INRCA - National Institute of Health and Science on Ageing, Via Santa Margherita, 5, Ancona, 60124, Italy, 39 071 800 4614, v.stara@inrca.it %K dementia %K older adults with dementia %K embodied conversational agent %K virtual personal assistant %K virtual agent %K virtual companion %K design for older adults with dementia %D 2021 %7 19.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Information and communication technologies are tools that are able to support cognitive functions, monitor health and movements, provide reminders to maintain residual memory abilities, and promote social support, especially among patients with dementia. Among these technologies, embodied conversational agents (ECAs) are seen as screen-based entities designed to stimulate human face-to-face conversation skills, allowing for natural human-machine interaction. Unfortunately, the evidence that such agents deliver care benefits in supporting people affected by dementia and their caregivers has not yet been well studied. Therefore, research in this area is essential for the entire scientific community. Objective: This study aims to evaluate the usability and acceptability of the virtual agent Anne by people living with dementia. The study is also designed to assess the ability of target users to use the system independently and receive valuable information from it. Methods: We conducted a 4-week trial that involved 20 older adults living with dementia and 14 family caregivers in home environment settings in Italy. This study used a mixed methods approach, balancing quantitative and qualitative instruments to gather data from users. Telemetry data were also collected. Results: Older users were particularly engaged in providing significant responses and participating in system improvements. Some of them clearly discussed how technical problems related to speech recognition had a negative impact on the intention to use, adaptiveness, usefulness, and trust. Moreover, the usability of the system achieved an encouraging score, and half of the sample recognized a role of the agent Anne. This study confirms that the quality of automatic speech recognition and synthesis is still a technical issue and has room for improvement, whereas the touch screen modality is almost stable and positively used by patients with dementia. Conclusions: This study demonstrated the ability of target users to use the system independently in their home environment; overall, the involved participants shared good engagement with the system, approaching the virtual agents as a companion able to support memory and enjoyment needs. Therefore, this research provides data that sustain the use of ECAs as future eHealth systems that are able to address the basic and higher-level needs of people living with dementia. This specific field of research is novel and poorly discussed in the scientific community. This could be because of its novelty, yet there is an urgent need to strengthen data, research, and innovation to accelerate the implementation of ECAs as a future method to offer nonpharmacological support to community-dwelling people with dementia. %M 34170256 %R 10.2196/25891 %U https://mhealth.jmir.org/2021/6/e25891/ %U https://doi.org/10.2196/25891 %U http://www.ncbi.nlm.nih.gov/pubmed/34170256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e17551 %T Reduction of Time on the Ground Related to Real-Time Video Detection of Falls in Memory Care Facilities: Observational Study %A Bayen,Eleonore %A Nickels,Shirley %A Xiong,Glen %A Jacquemot,Julien %A Subramaniam,Raghav %A Agrawal,Pulkit %A Hemraj,Raheema %A Bayen,Alexandre %A Miller,Bruce L %A Netscher,George %+ Department of Neuro-rehabilitation, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Sorbonne Université, 47 Bd de l'Hôpital, Paris, 75013, France, 33 142161101, eleonore.bayen@gbhi.org %K artificial intelligence %K video monitoring %K real-time video detection %K fall %K time on the ground %K Alzheimer disease %K dementia %K memory care facilities %D 2021 %7 17.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. Objective: This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. Methods: SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. Results: A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3% (78/141) of them spent less than 10 minutes on the ground. Conclusions: SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs. %M 34137723 %R 10.2196/17551 %U https://www.jmir.org/2021/6/e17551 %U https://doi.org/10.2196/17551 %U http://www.ncbi.nlm.nih.gov/pubmed/34137723 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26872 %T Brain Exercising Games With Consumer-Grade Single-Channel Electroencephalogram Neurofeedback: Pre-Post Intervention Study %A Israsena,Pasin %A Jirayucharoensak,Suwicha %A Hemrungrojn,Solaphat %A Pan-Ngum,Setha %+ National Electronics and Computer Technology Center, National Science and Technology Development Agency, 112 Thailand Science Park, Klong Luang, Pathumthani, 12120, Thailand, 66 25646900 ext 2471, pasin.israsena@nectec.or.th %K neurofeedback %K serious gaming %K serious game %K brain exercise %K cognition training %K EEG %K aging %K cognition %K cognitive %K brain game %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The aging population is one of the major challenges affecting societies worldwide. As the proportion of older people grows dramatically, so does the number of age-related illnesses such as dementia-related illnesses. Preventive care should be emphasized as an effective tool to combat and manage this situation. Objective: The aim of this pilot project was to study the benefits of using neurofeedback-based brain training games for enhancing cognitive performance in the elderly population. In particular, aiming for practicality, the training games were designed to operate with a low-cost consumer-grade single-channel electroencephalogram (EEG) headset that should make the service scalable and more accessible for wider adoption such as for home use. Methods: Our training system, which consisted of five brain exercise games using neurofeedback, was serviced at 5 hospitals in Thailand. Participants were screened for cognitive levels using the Thai Mental State Examination and Montreal Cognitive Assessment. Those who passed the criteria were further assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) computerized cognitive assessment battery. The physiological state of the brain was also assessed using 16-channel EEG. After 20 sessions of training, cognitive performance and EEG were assessed again to compare pretraining and posttraining results. Results: Thirty-five participants completed the training. CANTAB results showed positive and significant effects in the visual memory (delayed matching to sample [percent correct] P=.04), attention (median latency P=.009), and visual recognition (spatial working memory [between errors] P=.03) domains. EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area (P=.04), which similarly indicated improvement in the cognitive domain (attention). Conclusions: Outcomes of this study show the potential use of practical neurofeedback-based training games for brain exercise to enhance cognitive performance in the elderly population. %M 34128816 %R 10.2196/26872 %U https://games.jmir.org/2021/2/e26872 %U https://doi.org/10.2196/26872 %U http://www.ncbi.nlm.nih.gov/pubmed/34128816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27407 %T Association Between the Digital Clock Drawing Test and Neuropsychological Test Performance: Large Community-Based Prospective Cohort (Framingham Heart Study) %A Yuan,Jing %A Libon,David J %A Karjadi,Cody %A Ang,Alvin F A %A Devine,Sherral %A Auerbach,Sanford H %A Au,Rhoda %A Lin,Honghuang %+ Computational Biomedicine, School of Medicine, Boston University, 72 E. Concord Street, E-632, Boston, MA, 02118, United States, 1 617 358 0091, hhlin@bu.edu %K clock drawing test %K neuropsychological test %K cognition %K technology %K digital assessment %K mild cognitive impairment %K association %K neurology %K Framingham Heart Study %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Clock Drawing Test (CDT) has been widely used in clinic for cognitive assessment. Recently, a digital Clock Drawing Text (dCDT) that is able to capture the entire sequence of clock drawing behaviors was introduced. While a variety of domain-specific features can be derived from the dCDT, it has not yet been evaluated in a large community-based population whether the features derived from the dCDT correlate with cognitive function. Objective: We aimed to investigate the association between dCDT features and cognitive performance across multiple domains. Methods: Participants from the Framingham Heart Study, a large community-based cohort with longitudinal cognitive surveillance, who did not have dementia were included. Participants were administered both the dCDT and a standard protocol of neuropsychological tests that measured a wide range of cognitive functions. A total of 105 features were derived from the dCDT, and their associations with 18 neuropsychological tests were assessed with linear regression models adjusted for age and sex. Associations between a composite score from dCDT features were also assessed for associations with each neuropsychological test and cognitive status (clinically diagnosed mild cognitive impairment compared to normal cognition). Results: The study included 2062 participants (age: mean 62, SD 13 years, 51.6% women), among whom 36 were diagnosed with mild cognitive impairment. Each neuropsychological test was associated with an average of 50 dCDT features. The composite scores derived from dCDT features were significantly associated with both neuropsychological tests and mild cognitive impairment. Conclusions: The dCDT can potentially be used as a tool for cognitive assessment in large community-based populations. %M 34100766 %R 10.2196/27407 %U https://www.jmir.org/2021/6/e27407 %U https://doi.org/10.2196/27407 %U http://www.ncbi.nlm.nih.gov/pubmed/34100766 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25968 %T A Care Knowledge Management System Based on an Ontological Model of Caring for People With Dementia: Knowledge Representation and Development Study %A Kim,Gyungha %A Jeon,Hwawoo %A Park,Sung Kee %A Choi,Yong Suk %A Lim,Yoonseob %+ The Research Center for Diagnosis, Treatment and Care System of Dementia, Korea Institute of Science and Technology, 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul, KS013, Republic of Korea, 82 10 3700 3867, yslim@kist.re.kr %K caregiver %K caregiver for person with dementia %K knowledge model %K ontology %K knowledge management %K semantic reasoning %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Caregivers of people with dementia find it extremely difficult to choose the best care method because of complex environments and the variable symptoms of dementia. To alleviate this care burden, interventions have been proposed that use computer- or web-based applications. For example, an automatic diagnosis of the condition can improve the well-being of both the person with dementia and the caregiver. Other interventions support the individual with dementia in living independently. Objective: The aim of this study was to develop an ontology-based care knowledge management system for people with dementia that will provide caregivers with a care guide suited to the environment and to the individual patient’s symptoms. This should also enable knowledge sharing among caregivers. Methods: To build the care knowledge model, we reviewed existing ontologies that contain concepts and knowledge descriptions relating to the care of those with dementia, and we considered dementia care manuals. The basic concepts of the care ontology were confirmed by experts in Korea. To infer the different care methods required for the individual dementia patient, the reasoning rules as defined in Semantic Web Rule Languages and Prolog were utilized. The accuracy of the care knowledge in the ontological model and the usability of the proposed system were evaluated by using the Pellet reasoner and OntOlogy Pitfall Scanner!, and a survey and interviews were conducted with caregivers working in care centers in Korea. Results: The care knowledge model contains six top-level concepts: care knowledge, task, assessment, person, environment, and medical knowledge. Based on this ontological model of dementia care, caregivers at a dementia care facility in Korea were able to access the care knowledge easily through a graphical user interface. The evaluation by the care experts showed that the system contained accurate care knowledge and a level of assessment comparable to normal assessment tools. Conclusions: In this study, we developed a care knowledge system that can provide caregivers with care guides suited to individuals with dementia. We anticipate that the system could reduce the workload of caregivers. %M 34100762 %R 10.2196/25968 %U https://www.jmir.org/2021/6/e25968 %U https://doi.org/10.2196/25968 %U http://www.ncbi.nlm.nih.gov/pubmed/34100762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25006 %T Chatbots to Support People With Dementia and Their Caregivers: Systematic Review of Functions and Quality %A Ruggiano,Nicole %A Brown,Ellen L %A Roberts,Lisa %A Framil Suarez,C Victoria %A Luo,Yan %A Hao,Zhichao %A Hristidis,Vagelis %+ Department of Computer Science and Engineering, University of California, Riverside, 317 Winston Chung Hall, 900 University Ave, Riverside, CA, 92521, United States, 1 951 827 2478, vagelis@cs.ucr.edu %K dementia %K caregivers %K chatbots %K conversation agents %K mobile apps %K mobile phone %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the past decade, there has been an increase in the use of information technologies to educate and support people with dementia and their family caregivers. At the same time, chatbot technologies have become increasingly popular for use by the public and have been identified as having benefits for health care delivery. However, little is known about how chatbot technologies may benefit people with dementia and their caregivers. Objective: This study aims to identify the types of current commercially available chatbots that are designed for use by people with dementia and their caregivers and to assess their quality in terms of features and content. Methods: Chatbots were identified through a systematic search on Google Play Store, Apple App Store, Alexa Skills, and the internet. An evidence-based assessment tool was used to evaluate the features and content of the identified apps. The assessment was conducted through interrater agreement among 4 separate reviewers. Results: Of the 505 initial chatbots identified, 6 were included in the review. The chatbots assessed varied significantly in terms of content and scope. Although the chatbots were generally found to be easy to use, some limitations were noted regarding their performance and programmed content for dialog. Conclusions: Although chatbot technologies are well established and commonly used by the public, their development for people with dementia and their caregivers is in its infancy. Given the successful use of chatbots in other health care settings and for other applications, there are opportunities to integrate this technology into dementia care. However, more evidence-based chatbots that have undergone end user evaluation are needed to evaluate their potential to adequately educate and support these populations. %M 34081019 %R 10.2196/25006 %U https://www.jmir.org/2021/6/e25006 %U https://doi.org/10.2196/25006 %U http://www.ncbi.nlm.nih.gov/pubmed/34081019 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e24724 %T Business Models of eHealth Interventions to Support Informal Caregivers of People With Dementia in the Netherlands: Analysis of Case Studies %A Christie,Hannah Liane %A Boots,Lizzy Mitzy Maria %A Hermans,Ivo %A Govers,Mark %A Tange,Huibert Johannes %A Verhey,Frans Rochus Josef %A de Vugt,Majolein %+ Alzheimer Centrum Limburg, Maastricht University, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 456 21 30 78, hannah.christie@maastrichtuniversity.nl %K eHealth %K dementia %K caregiving %K implementation %K business modeling %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Aging %G English %X Background: In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented in practice, and much can be learned from their counterparts (commercial, governmental, or other origins) that are already being used in practice. Objective: This study aims to examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia that are currently used in the Netherlands; to investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions; and to apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. Methods: In step 1, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: delivered via the internet; suitable for informal caregivers of people with dementia; accessible in the Netherlands, either in Dutch or in English; and used in practice. The contacted experts were academics working on dementia and psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organizations, and people with dementia and their caregivers. In step 2, contact persons from the suggested eHealth interventions participated in a semistructured telephone interview. The results were analyzed using a multiple case study methodology. Results: In total, the response rate was 7.5% (36/483), and 21 eHealth interventions for caregivers of people with dementia were recommended. Furthermore, 43% (9/21) of the interventions met all 4 criteria and were included in the sample for the case study analysis. Of these 9 interventions, 4 were found to have developed sustainable business models and 5 were implemented in a more exploratory manner and relied on research grants to varying extents, although some had also developed preliminary business models. Conclusions: These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology services externally, and their offer of fixed, low pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modeling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice. %M 34081009 %R 10.2196/24724 %U https://aging.jmir.org/2021/2/e24724 %U https://doi.org/10.2196/24724 %U http://www.ncbi.nlm.nih.gov/pubmed/34081009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e26462 %T Sleep Detection for Younger Adults, Healthy Older Adults, and Older Adults Living With Dementia Using Wrist Temperature and Actigraphy: Prototype Testing and Case Study Analysis %A Wei,Jing %A Boger,Jennifer %+ Department of Systems Design Engineering, University of Waterloo, Engineering 5, 6th Floor, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 38328, jboger@uwaterloo.ca %K sleep monitoring %K wearables %K accelerometer %K wrist temperature %K circadian rhythm %K younger adults %K older adults %K dementia %K mobile phone %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sleep is essential for one’s health and quality of life. Wearable technologies that use motion and temperature sensors have made it possible to self-monitor sleep. Although there is a growing body of research on sleep monitoring using wearable devices for healthy young-to-middle-aged adults, few studies have focused on older adults, including those living with dementia. Objective: This study aims to investigate the impact of age and dementia on sleep detection through movement and wrist temperature. Methods: A total of 10 younger adults, 10 healthy older adults, and 8 older adults living with dementia (OAWD) were recruited. Each participant wore a Mi Band 2 (accemetry-based sleep detection) and our custom-built wristband (actigraphy and wrist temperature) 24 hours a day for 2 weeks and was asked to keep a daily sleep journal. Sleep parameters detected by the Mi Band 2 were compared with sleep journals, and visual analysis of actigraphy and temperature data was performed. Results: The absolute differences in sleep onset and offset between the sleep journals and Mi Band 2 were 39 (SD 51) minutes and 31 (SD 52) minutes for younger adults, 49 (SD 58) minutes and 33 (SD 58) minutes for older adults, and 253 (SD 104) minutes and 161 (SD 94) minutes for OAWD. The Mi Band 2 was unable to accurately detect sleep in 3 healthy older adults and all OAWDs. The average sleep and wake temperature difference of OAWD (1.26 °C, SD 0.82 °C) was significantly lower than that of healthy older adults (2.04 °C, SD 0.70 °C) and healthy younger adults (2.48 °C, SD 0.88 °C). Actigraphy data showed that older adults had more movement during sleep compared with younger adults and that this trend appears to increase for those with dementia. Conclusions: The Mi Band 2 did not accurately detect sleep in older adults who had greater levels of nighttime movement. As more nighttime movement appears to be a phenomenon that increases in prevalence with age and even more so with dementia, further research needs to be conducted with a larger sample size and greater diversity of commercially available wearable devices to explore these trends more conclusively. All participants, including older adults and OAWD, had a distinct sleep and wake wrist temperature contrast, which suggests that wrist temperature could be leveraged to create more robust and broadly applicable sleep detection algorithms. %M 34061038 %R 10.2196/26462 %U https://mhealth.jmir.org/2021/6/e26462 %U https://doi.org/10.2196/26462 %U http://www.ncbi.nlm.nih.gov/pubmed/34061038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25705 %T A Digital Platform for Facilitating Personalized Dementia Care in Nursing Homes: Formative Evaluation Study %A Wang,Gubing %A Albayrak,Armagan %A Kortuem,Gerd %A van der Cammen,Tischa JM %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 655548210, g.wang-2@tudelft.nl %K human-centered design %K data visualizations %K person-centered care %K people with dementia %K assistive technology %K health care design %K care management %K internet of things %K data-driven design %K data-enabled design %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Care personalization is key to the well-being of people with dementia according to person-centered care. With the development of the internet of things, a large quantity of personal data can be collected securely and reliably, which has the potential to facilitate care personalization for people with dementia. Yet, there are limited assistive technologies developed for this purpose, and the user acceptance of assistive technologies is low in nursing homes. Therefore, through a data-enabled design approach, a digital platform was developed for helping the care team in a nursing home to personalize dementia care, specifically in the management of behavioral and psychological dementia symptoms. Objective: This study aimed to evaluate the digital platform in a real-life context with potential users from the following two aspects: (1) to explore if the digital platform could help with generating insights on the current state of each person with dementia and (2) to gather feedback on the digital platform from the care team. Methods: The digital platform was deployed in the nursing home for 7 weeks and the data collected were visualized and presented to the care team via the digital platform. The visualizations were analyzed by the researchers for pattern detection. Meanwhile, the care team was asked to examine the visualizations and were interviewed for the following: (1) if any insights and actions were generated from the examination, (2) the usefulness of the digital platform, and (3) the improvements they would like to see. Results: The data collected on the digital platform demonstrated its potential for pattern detection. Insights were generated by the care team and categorized into “client level,” “ward level,” and “team level.” The corresponding actions taken by the care team were classified into “investigation” and “implementation.” User acceptance varied across the care team, and three aspects of improvement for the digital platform were identified. Conclusions: By evaluating the digital platform, this study gained insights on applying data-enabled design for personalizing dementia care; besides, it offers future researchers some recommendations on how to integrate assistive technologies in the nursing home context. %M 34047703 %R 10.2196/25705 %U https://formative.jmir.org/2021/5/e25705 %U https://doi.org/10.2196/25705 %U http://www.ncbi.nlm.nih.gov/pubmed/34047703 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25520 %T Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Holyoke,Paul %+ Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia %K neuropsychological tests %K evaluation study %K technology %K aged %K primary health care %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage. Objective: We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers’ (HCP) perceptions of its success as a screening tool. Patients’ perceptions of completing the SCREEN and its impact on their quality of life will also be explored. Methods: This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI. Results: This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress. Conclusions: At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted. International Registered Report Identifier (IRRID): DERR1-10.2196/25520 %M 34018966 %R 10.2196/25520 %U https://www.researchprotocols.org/2021/5/e25520 %U https://doi.org/10.2196/25520 %U http://www.ncbi.nlm.nih.gov/pubmed/34018966 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e21900 %T A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study %A Khaleghi,Ali %A Aghaei,Zahra %A Mahdavi,Mohammad Amin %+ Department of Computer Engineering, Imam Khomeini International University, Norouzian Boulevard, Qazvin, Iran, 98 9121003006, ali.khaleghi.ir@gmail.com %K cognitive tasks %K boredom %K motivation %K gamification %K game elements %K framework %K process %K gamification design %K cognitive training %K cognitive assessment %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive tasks designed to measure or train cognition are often repetitive and presented in a monotonous manner, features that lead to participant boredom and disengagement. In this situation, participants do not put forth their best effort to do these tasks well. As a result, neuropsychologists cannot draw accurate conclusions about the data collected, and intervention effects are reduced. It is assumed that greater engagement and motivation will manifest as improved data quality. Gamification, the use of game elements in nongame settings, has been heralded as a potential mechanism for increasing participant engagement in cognitive tasks. Some studies have reported a positive effect of gamification on participant performance, although most studies have shown mixed results. One reason for these contrasting findings is that most studies have applied poor and heterogeneous design techniques to gamify cognitive tasks. Therefore, an appropriate gamification design framework is needed in these tasks. Objective: This study aimed to propose a framework to guide the design of gamification in cognitive tasks. Methods: We employed a design science research (DSR) approach to provide a framework for gamifying cognitive assessments and training by synthesizing current gamification design frameworks and gamification works in cognitive assessment and training, as well as incorporating field experiences. The prototypes of the framework were iteratively evaluated with 17 relevant experts. Results: We proposed a framework consisting of 7 phases: (1) preparation; (2) knowing users; (3) exploring existing tools for assessing or training a targeted cognitive context and determining the suitability of game-up and mapping techniques; (4) ideation; (5) prototyping using the Objects, Mechanics, Dynamics, Emotions (OMDE) design guideline; (6) development; and (7) disseminating and monitoring. Conclusions: We found that (1) an intermediate design framework is needed to gamify cognitive tasks, which means that game elements should be selected by considering current cognitive assessment or training context characteristics since game elements may impose an irrelevant cognitive load that, in turn, can jeopardize data quality; (2) in addition to developing a new gamified cognitive task from scratch, 2 gamification techniques are widely used (first, adding game elements to an existing cognitive task and second, mapping an existing game to a cognitive function or impairment to assess or train it); and (3) further research is required to investigate the interplay of cognitive processes and game mechanics. %M 33819164 %R 10.2196/21900 %U https://games.jmir.org/2021/2/e21900 %U https://doi.org/10.2196/21900 %U http://www.ncbi.nlm.nih.gov/pubmed/33819164 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26431 %T Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guerrero-Pertiñez,Gloria %A Barnestein-Fonseca,Pilar %A Guzman-Parra,Jose %A Vega-Nuñez,Amanda %A Varela-Moreno,Esperanza %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K caregiver %K cognition %K cognitive impairment %K cohort %K COVID-19 %K dementia %K older people %K informal caregivers %K information and communications technologies %K isolation %K older adults %K outcome %K quality of life %K social isolation %K stress %K technologies %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure. Objective: The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies. Methods: This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100). Results: As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used. Conclusions: If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): DERR1-10.2196/26431 %M 33909588 %R 10.2196/26431 %U https://www.researchprotocols.org/2021/5/e26431 %U https://doi.org/10.2196/26431 %U http://www.ncbi.nlm.nih.gov/pubmed/33909588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25233 %T Individual Differences and Features of Self-reported Memory Lapses as Risk Factors for Alzheimer Disease Among Adults Aged 50 Years and Older: Protocol for a Coordinated Analysis Across Two Longitudinal Data Sets %A Mogle,Jacqueline %A Hill,Nikki L %A Turner,Jennifer R %+ Edna Bennett Pierce Prevention Research Center, College of Health and Human Development, Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 865 1334, jam935@psu.edu %K subjective memory %K individual differences %K Alzheimer disease %K daily assessment %K multilevel modeling %K coordinated analysis %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increasing evidence has promoted the clinical utility of self-reported memory problems for detecting early impairment associated with Alzheimer disease (AD). However, previous studies investigating memory problems often conflated the types of problems (ie, retrospective and prospective) with their features (ie, frequency and consequences). This bias limits the specificity of traditional measures of memory problems and minimizes their ability to detect differential trajectories associated with cognitive decline. In this study, we use a novel measure of self-reported memory problems that uses daily reports of memory lapses to disentangle types from features for analyzing the impact of each dimension in two longitudinal data sets. Furthermore, this study explores the individual difference factors of age and gender as potential moderators of the relationships between self-reported memory lapses and objective cognitive decline. Objective: The aim of this study is to describe the protocol for a secondary data analysis project that explores the relationship between experiences of daily memory lapses and their associations with cognitive decline in middle-aged and older adults. Methods: This study uses multilevel, coordinated analyses across two measurement burst data sets to examine the links between features and consequences of memory lapses (retrospective and prospective) and their association with objective cognitive decline. This study’s sample (N=392; aged 50-85 years; n=254, 64.8% women) is drawn from two ongoing, nationally funded research studies: The Effects of Stress on Cognitive Aging, Physiology, and Emotion study and the Einstein Aging Study. Both studies assess the daily experience of memory lapses, including the type as well as the emotional and functional outcomes, and objective measures of cognition, such as processing speed and episodic memory. We will use multilevel modeling to test our conceptual model demonstrating that differences in frequency and types of memory lapses show differential trends in their relationships with cognitive decline and that these relationships vary by the age and gender of participants. Results: This project was funded in August 2019. The approval for secondary data analysis was given by the institutional review board in February 2020. Data analysis for this project has not yet started. Conclusions: The early and accurate identification of individuals most at risk for cognitive decline is of paramount importance. Previous research exploring self-reported memory problems and AD is promising; however, limitations in measurement may explain previous reports of inconsistences. This study addresses these concerns by examining daily reports of memory lapses, how these vary by age and gender, and their relationship with objective cognitive performance. Overall, this study aims to identify the key features of daily memory lapses and the differential trajectories that best predict cognitive decline to help inform future AD risk screening tools. International Registered Report Identifier (IRRID): DERR1-10.2196/25233 %M 33988514 %R 10.2196/25233 %U https://www.researchprotocols.org/2021/5/e25233 %U https://doi.org/10.2196/25233 %U http://www.ncbi.nlm.nih.gov/pubmed/33988514 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28684 %T Interrupting Sitting Time in Postmenopausal Women: Protocol for the Rise for Health Randomized Controlled Trial %A Hartman,Sheri J %A Dillon,Lindsay W %A LaCroix,Andrea Z %A Natarajan,Loki %A Sears,Dorothy D %A Owen,Neville %A Dunstan,David W %A Sallis,James F %A Schenk,Simon %A Allison,Matthew %A Takemoto,Michelle %A Herweck,Alexandra M %A Nguyen,Bao %A Rosenberg,Dori E %+ Hebert Wertheim School of Public Health, University of California, San Diego, 3855 Health Sciences Drive, Mail Code 0901, La Jolla, CA, , United States, 1 858 534 9235, sjhartman@ucsd.edu %K sedentary behavior %K cardiometabolic health %K older adults %K physical function %K cognitive function %K biomarkers %D 2021 %7 13.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many older adults spend the majority of their waking hours sitting, which increases their risk of chronic diseases. Given the challenges that many older adults face when engaging in moderate-to-vigorous physical activity, understanding the health benefits of decreasing sitting time and increasing the number of sit-to-stand transitions is needed to address this growing public health concern. Objective: The aim of this 3-arm randomized controlled trial is to investigate how changes in sitting time and brief sit-to-stand transitions impact biomarkers of healthy aging and physical, emotional, and cognitive functioning compared with a healthy attention control arm. Methods: Sedentary and postmenopausal women (N=405) will be recruited and randomly assigned to 1 of the 3 study conditions for 3 months: healthy living attention control (Healthy Living), reduce sitting time (Reduce Sitting), and increase sit-to-stand transitions (Increase Transitions). Assessments conducted at baseline and 3 months included fasting blood draw, blood pressure, anthropometric measurements, physical functioning, cognitive testing, and 7 days of a thigh-worn accelerometer (activPAL) and a hip-worn accelerometer (ActiGraph). Blood-based biomarkers of healthy aging included those associated with glycemic control (glycated hemoglobin, fasting plasma insulin and glucose, and homeostatic model assessment of insulin resistance). Results: Recruitment began in May 2018. The intervention is ongoing, with data collection expected to continue through the end of 2022. Conclusions: The Rise for Health study is designed to test whether 2 different approaches to interrupting sitting time can improve healthy aging in postmenopausal women. Results from this study may inform the development of sedentary behavior guidelines and interventions to reduce sitting time in older adults. Trial Registration: ClinicalTrials.gov NCT03473145; https://clinicaltrials.gov/ct2/show/NCT03473145 International Registered Report Identifier (IRRID): DERR1-10.2196/28684 %M 33983131 %R 10.2196/28684 %U https://www.researchprotocols.org/2021/5/e28684 %U https://doi.org/10.2196/28684 %U http://www.ncbi.nlm.nih.gov/pubmed/33983131 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e27113 %T Learning From Clinical Consensus Diagnosis in India to Facilitate Automatic Classification of Dementia: Machine Learning Study %A Jin,Haomiao %A Chien,Sandy %A Meijer,Erik %A Khobragade,Pranali %A Lee,Jinkook %+ Center for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, United States, 1 626 554 3370, haomiaoj@usc.edu %K dementia %K Alzheimer disease %K machine learning %K artificial intelligence %K diagnosis %K classification %K India %K model %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) is the first and only nationally representative study on late-life cognition and dementia in India (n=4096). LASI-DAD obtained clinical consensus diagnosis of dementia for a subsample of 2528 respondents. Objective: This study develops a machine learning model that uses data from the clinical consensus diagnosis in LASI-DAD to support the classification of dementia status. Methods: Clinicians were presented with the extensive data collected from LASI-DAD, including sociodemographic information and health history of respondents, results from the screening tests of cognitive status, and information obtained from informant interviews. Based on the Clinical Dementia Rating (CDR) and using an online platform, clinicians individually evaluated each case and then reached a consensus diagnosis. A 2-step procedure was implemented to train several candidate machine learning models, which were evaluated using a separate test set for predictive accuracy measurement, including the area under receiver operating curve (AUROC), accuracy, sensitivity, specificity, precision, F1 score, and kappa statistic. The ultimate model was selected based on overall agreement as measured by kappa. We further examined the overall accuracy and agreement with the final consensus diagnoses between the selected machine learning model and individual clinicians who participated in the clinical consensus diagnostic process. Finally, we applied the selected model to a subgroup of LASI-DAD participants for whom the clinical consensus diagnosis was not obtained to predict their dementia status. Results: Among the 2528 individuals who received clinical consensus diagnosis, 192 (6.7% after adjusting for sampling weight) were diagnosed with dementia. All candidate machine learning models achieved outstanding discriminative ability, as indicated by AUROC >.90, and had similar accuracy and specificity (both around 0.95). The support vector machine model outperformed other models with the highest sensitivity (0.81), F1 score (0.72), and kappa (.70, indicating substantial agreement) and the second highest precision (0.65). As a result, the support vector machine was selected as the ultimate model. Further examination revealed that overall accuracy and agreement were similar between the selected model and individual clinicians. Application of the prediction model on 1568 individuals without clinical consensus diagnosis classified 127 individuals as living with dementia. After applying sampling weight, we can estimate the prevalence of dementia in the population as 7.4%. Conclusions: The selected machine learning model has outstanding discriminative ability and substantial agreement with a clinical consensus diagnosis of dementia. The model can serve as a computer model of the clinical knowledge and experience encoded in the clinical consensus diagnostic process and has many potential applications, including predicting missed dementia diagnoses and serving as a clinical decision support tool or virtual rater to assist diagnosis of dementia. %M 33970122 %R 10.2196/27113 %U https://mental.jmir.org/2021/5/e27113 %U https://doi.org/10.2196/27113 %U http://www.ncbi.nlm.nih.gov/pubmed/33970122 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24526 %T Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial %A Kang,Jae Myeong %A Kim,Nambeom %A Lee,Sook Young %A Woo,Soo Kyun %A Park,Geumjin %A Yeon,Byeong Kil %A Park,Jung Woon %A Youn,Jung-Hae %A Ryu,Seung-Ho %A Lee,Jun-Young %A Cho,Seong-Jin %+ Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, 21, 774-gil, Namdong-daero, Namdong-gu, Incheon, 21565, Republic of Korea, 82 32 460 8420, sjcho@gilhospital.com %K virtual reality %K cognitive training %K visuospatial function %K fMRI %K visual network %K mild cognitive impairment %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive training can potentially prevent cognitive decline. However, the results of recent studies using semi-immersive virtual reality (VR)-assisted cognitive training are inconsistent. Objective: We aimed to examine the hypothesis that cognitive training using fully immersive VR, which may facilitate visuospatial processes, could improve visuospatial functioning, comprehensive neuropsychological functioning, psychiatric symptoms, and functional connectivity in the visual brain network in predementia. Methods: Participants over 60 years old with subjective cognitive decline or mild cognitive impairment from a memory clinic were randomly allocated to the VR (n=23) or the control (n=18) group. The VR group participants received multidomain and neuropsychologist-assisted cognitive training in a fully immersive VR environment twice a week for 1 month. The control group participants did not undergo any additional intervention except for their usual therapy such as pharmacotherapy. Participants of both groups were evaluated for cognitive function using face-to-face comprehensive neuropsychological tests, including the Rey-Osterrieth Complex Figure Test (RCFT) copy task; for psychiatric symptoms such as depression, apathy, affect, and quality of life; as well as resting-state functional magnetic resonance imaging (rsfMRI) at baseline and after training. Repeated-measures analysis of variance was used to compare the effect of cognitive training between groups. Seed-to-voxel–based analyses were used to identify the cognitive improvement–related functional connectivity in the visual network of the brain. Results: After VR cognitive training, significant improvement was found in the total score (F1,39=14.69, P=.001) and basic components score of the RCFT copy task (F1,39=9.27, P=.005) compared with those of the control group. The VR group also showed improvements, albeit not significant, in naming ability (F1,39=3.55, P=.07), verbal memory delayed recall (F1,39=3.03, P=.09), and phonemic fluency (F1,39=3.08, P=.09). Improvements in psychiatric symptoms such as apathy (F1,39=7.02, P=.01), affect (F1,39=14.40, P=.001 for positive affect; F1,39=4.23, P=.047 for negative affect), and quality of life (F1,39=4.49, P=.04) were found in the VR group compared to the control group. Improvement in the RCFT copy task was associated with a frontal-occipital functional connectivity increase revealed by rsfMRI in the VR group compared to the control group. Conclusions: Fully immersive VR cognitive training had positive effects on the visuospatial function, apathy, affect, quality of life, and increased frontal-occipital functional connectivity in older people in a predementia state. Future trials using VR cognitive training with larger sample sizes and more sophisticated designs over a longer duration may reveal greater improvements in cognition, psychiatric symptoms, and brain functional connectivity. Trial Registration: Clinical Research Information Service KCT0005243; https://tinyurl.com/2a4kfasa %M 33955835 %R 10.2196/24526 %U https://www.jmir.org/2021/5/e24526 %U https://doi.org/10.2196/24526 %U http://www.ncbi.nlm.nih.gov/pubmed/33955835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25082 %T Testing a Novel Web-Based Neurocognitive Battery in the General Community: Validation and Usability Study %A Capizzi,Riley %A Fisher,Melissa %A Biagianti,Bruno %A Ghiasi,Neelufaer %A Currie,Ariel %A Fitzpatrick,Karrie %A Albertini,Nicholas %A Vinogradov,Sophia %+ Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 (847) 997 4148, capizzi@temple.edu %K cognition %K normative %K remote %K digital %K online %K web-based %K BrainHQ %K Posit Science Corporation %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, there has been increased interest in the development of remote psychological assessments. These platforms increase accessibility and allow clinicians to monitor important health metrics, thereby informing patient-centered treatment. Objective: In this study, we report the properties and usability of a new web-based neurocognitive assessment battery and present a normative data set for future use. Methods: A total of 781 participants completed a portion of 8 tasks that captured performance in auditory processing, visual-spatial working memory, visual-spatial learning, cognitive flexibility, and emotional processing. A subset of individuals (n=195) completed a 5-question survey measuring the acceptability of the tasks. Results: Between 252 and 426 participants completed each task. Younger individuals outperformed their older counterparts in 6 of the 8 tasks. Therefore, central tendency data metrics were presented using 7 different age bins. The broad majority of participants found the tasks interesting and enjoyable and endorsed some interest in playing them at home. Only 1 of 195 individuals endorsed not at all for the statement, “I understood the instructions.” Older individuals were less likely to understand the instructions; however, 72% (49/68) of individuals over the age of 60 years still felt that they mostly or very much understood the instructions. Conclusions: Overall, the tasks were found to be widely acceptable to the participants. The use of web-based neurocognitive tasks such as these may increase the ability to deploy precise data-informed interventions to a wider population. %M 33955839 %R 10.2196/25082 %U https://www.jmir.org/2021/5/e25082 %U https://doi.org/10.2196/25082 %U http://www.ncbi.nlm.nih.gov/pubmed/33955839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e25706 %T Benefiting From Digital Use: Prospective Association of Internet Use With Knowledge and Preventive Behaviors Related to Alzheimer Disease in the Israeli Survey of Aging %A Neter,Efrat %A Chachashvili-Bolotin,Svetlana %A Erlich,Bracha %A Ifrah,Kfir %+ Department Behavioral Sciences, Faculty of Social & Community Sciences, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, Israel, 972 546462677, neter@ruppin.ac.il %K Alzheimer disease %K digital benefits %K digital divide %K digital skills %K internet use %K health behaviors %K social capital %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Previous work documented the beneficial association between internet use and improved cognition, functional capacity, and less cognitive decline among people in late adulthood. This work focused on potential mechanisms of such an association: knowledge on Alzheimer disease (AD) and preventive behaviors related to AD. Objective: The aim of this study was to examine prospective associations of internet use and perceived computer skills with knowledge on AD and preventive behaviors related to AD. Methods: The sample included 1232 older adults (mean age 71.12 [SD 9.07]) drawn from the Israeli branch of the Survey of Health, Aging, and Retirement in Europe (SHARE-Israel). The sample is representative of Israeli households of adults aged 50 or older and their spouses. Data analyzed were collected in person during 2015 (Wave 6), and in a drop-off questionnaire following the in-person 2017 data collection (Wave 7). Results: Although both internet use and perceived computer skills were prospectively associated with knowledge and behaviors related to AD in bivariate analyses, after controlling for sociodemographics, only internet use was associated with more such knowledge (β=.13, P<.001) and behaviors (β=.22, P<.001). Conclusions: Internet use emerged as a prospective predictor of protective factors against AD. Policymakers should advance digital engagement so as to enhance knowledge on AD and preventive behaviors among older adults. %M 33929331 %R 10.2196/25706 %U https://aging.jmir.org/2021/2/e25706 %U https://doi.org/10.2196/25706 %U http://www.ncbi.nlm.nih.gov/pubmed/33929331 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25462 %T Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial %A Yeo,Pei Shi %A Nguyen,Tu Ngoc %A Ng,Mary Pei Ern %A Choo,Robin Wai Munn %A Yap,Philip Lin Kiat %A Ng,Tze Pin %A Wee,Shiou Liang %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Tower E, Level 4, Singapore, 768024, Singapore, 65 6592 4606, weeshiouliang@gmail.com %K group-based computerized cognitive training %K cognition %K gait %K community program implementation %K healthy older adults %K cognitive %K community program %K cognitive training %K elderly %K aging %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive training can improve cognition in healthy older adults. Objective: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=–0.57, P=.01, 95% CI [–1.00 to –0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=–13.5, P=.01, 95% CI [–23.95 to –3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [–0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=–0.36, P=.08, 95% CI [–0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [–0.05 to 0.96]) that were not statistically significant. Conclusions: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. Trial Registration: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591 %M 33904819 %R 10.2196/25462 %U https://formative.jmir.org/2021/4/e25462 %U https://doi.org/10.2196/25462 %U http://www.ncbi.nlm.nih.gov/pubmed/33904819 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e21808 %T Mobile Apps to Support Family Caregivers of People With Alzheimer Disease and Related Dementias in Managing Disruptive Behaviors: Qualitative Study With Users Embedded in a Scoping Review %A Désormeaux-Moreau,Marjorie %A Michel,Charlie-Maude %A Vallières,Mélanie %A Racine,Maryse %A Poulin-Paquet,Myriame %A Lacasse,Delphine %A Gionet,Pascale %A Genereux,Melissa %A Lachiheb,Wael %A Provencher,Véronique %+ School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12 Avenue N, Sherbrooke, QC, Canada, 1 819 791 7904 ext 70525, veronique.provencher@usherbrooke.ca %K disruptive behaviors management %K dementia %K caregivers %K mobile phone %K app %K scoping review %K focus group %K mHealth %K neurocognitive disorder %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: People with Alzheimer disease and related dementias often display disruptive behaviors (eg, aggression, wandering, and restlessness), which increase family caregivers’ burden of care. However, there are few tools currently available to help these caregivers manage disruptive behaviors. Mobile apps could meet this need, but to date little is known about them. Objective: The aims of our study were to identify existing mobile apps designed to support family caregivers of people with Alzheimer disease and related dementias in managing disruptive behaviors; explore whether family caregivers view these mobile apps as relevant to meeting their needs and as useful in managing disruptive behaviors; and document the types of mobile apps that are of interest and appeal to most family caregivers (with regard to format, ergonomics, and clarity). Methods: A review of mobile apps initially conducted in February 2018 was updated in March 2019 with 2 platforms (App Store [Apple Inc.] and Google Play [Google]). The selected apps were first analyzed independently by 3 raters (2 students and 1 researcher) for each of the platforms. A focus group discussion was then held with 4 family caregivers to explore their perceptions of the apps according to their needs and interests. The content of the discussion was analyzed. Results: Initially, 7 of 118 apps identified met the inclusion criteria. An eighth app, recommended by one of the knowledge users, was added later. Four family caregivers (women aged between 58 and 78 years) participated in the discussion. Participants expressed a preference for easy-to-understand apps that provide concrete intervention strategies. They reported being most inclined to use two apps, Dementia Advisor and DTA Behaviours. Conclusions: Few mobile apps on the market meet the needs of family caregivers in terms of content and usability. Our results could help to address this gap by identifying what family caregivers deem relevant in a mobile app to help them manage disruptive behaviors. %M 33861207 %R 10.2196/21808 %U https://aging.jmir.org/2021/2/e21808 %U https://doi.org/10.2196/21808 %U http://www.ncbi.nlm.nih.gov/pubmed/33861207 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26875 %T Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers %A Wrede,Christian %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 (0)53 489 7537, c.wrede@utwente.nl %K in-home monitoring %K ambient assisted living %K assistive technologies %K dementia %K home care %K informal care %K aging in place %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. %M 33843596 %R 10.2196/26875 %U https://aging.jmir.org/2021/2/e26875 %U https://doi.org/10.2196/26875 %U http://www.ncbi.nlm.nih.gov/pubmed/33843596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27667 %T Using Speech Data From Interactions With a Voice Assistant to Predict the Risk of Future Accidents for Older Drivers: Prospective Cohort Study %A Yamada,Yasunori %A Shinkawa,Kaoru %A Kobayashi,Masatomo %A Takagi,Hironobu %A Nemoto,Miyuki %A Nemoto,Kiyotaka %A Arai,Tetsuaki %+ IBM Research, Nihonbashi, Hakozaki-cho, Chuo-ku, Tokyo, 103-8510, Japan, 81 80 6706 9381, ysnr@jp.ibm.com %K cognitive impairment %K smart speaker %K speech analysis %K accident %K prevention %K older adults %K prediction %K risk %K assistant %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid growth of the older adult population worldwide, car accidents involving this population group have become an increasingly serious problem. Cognitive impairment, which is assessed using neuropsychological tests, has been reported as a risk factor for being involved in car accidents; however, it remains unclear whether this risk can be predicted using daily behavior data. Objective: The objective of this study was to investigate whether speech data that can be collected in everyday life can be used to predict the risk of an older driver being involved in a car accident. Methods: At baseline, we collected (1) speech data during interactions with a voice assistant and (2) cognitive assessment data—neuropsychological tests (Mini-Mental State Examination, revised Wechsler immediate and delayed logical memory, Frontal Assessment Battery, trail making test-parts A and B, and Clock Drawing Test), Geriatric Depression Scale, magnetic resonance imaging, and demographics (age, sex, education)—from older adults. Approximately one-and-a-half years later, we followed up to collect information about their driving experiences (with respect to car accidents) using a questionnaire. We investigated the association between speech data and future accident risk using statistical analysis and machine learning models. Results: We found that older drivers (n=60) with accident or near-accident experiences had statistically discernible differences in speech features that suggest cognitive impairment such as reduced speech rate (P=.048) and increased response time (P=.040). Moreover, the model that used speech features could predict future accident or near-accident experiences with 81.7% accuracy, which was 6.7% higher than that using cognitive assessment data, and could achieve up to 88.3% accuracy when the model used both types of data. Conclusions: Our study provides the first empirical results that suggest analysis of speech data recorded during interactions with voice assistants could help predict future accident risk for older drivers by capturing subtle impairments in cognitive function. %M 33830066 %R 10.2196/27667 %U https://www.jmir.org/2021/4/e27667 %U https://doi.org/10.2196/27667 %U http://www.ncbi.nlm.nih.gov/pubmed/33830066 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24628 %T An Individual Cognitive Stimulation Therapy App for People With Dementia and Their Carers: Protocol for a Feasibility Randomized Controlled Trial %A Rai,Harleen Kaur %A Schneider,Justine %A Orrell,Martin %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1157484252, Harleen.Rai@nottingham.ac.uk %K dementia %K cognitive stimulation therapy %K touchscreen technology %K feasibility trial %K quality of life %K mHealth %K apps %D 2021 %7 8.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a need for more resources to support the cognition and quality of life of people with dementia. The individual cognitive stimulation therapy (iCST) app aims to provide cognitive stimulation and social interaction to people with dementia and carers through interactive touchscreen technology. The iCST app has been developed according to the principles of CST and iCST, which have previously shown to improve the cognition and quality of life of people with dementia and benefit the relationship between the person with dementia and his/her carer. The iCST app has also shown to improve the quality of the carer’s life. Objective: The aim of this study is to evaluate the usability of the iCST app intervention and the feasibility of conducting a full-scale randomized controlled trial (RCT) to assess the clinical effectiveness of the iCST app intervention compared to that of treatment-as-usual for people with mild-to-moderate dementia. Methods: We aim to recruit 60 people with mild-to-moderate dementia and their informal carers as dyads in a multi-center feasibility RCT with a treatment-as-usual control group. Both parties must be able to provide informed consent and participate in the intervention. Dyads will complete a baseline assessment that will include cognition and quality of life measures and they will subsequently be randomized (1:1) to the iCST app intervention in addition to usual care or to usual care only. All participants will be followed up at 5 weeks and at 11 weeks after the baseline assessments. A range of feasibility outcomes will be assessed, including recruitment and retention rates, intervention fidelity and usability, and acceptability of the outcome measures. A sample of the experimental group will be invited to a semistructured posttrial interview to further examine the experience of using the iCST app. Results: This study received funding in May 2015 and obtained ethical approval in March 2018. Data collection began in November 2018 and was completed in March 2020 with a total of 61 dyads recruited. Data analyses are in progress and the final results are expected to be available in the spring of 2021. Conclusions: This study will investigate whether it is feasible to conduct a full-scale RCT to evaluate the clinical effectiveness of the iCST app in comparison to that of usual care alone. In addition, this study will examine the usability of the iCST app. The data will provide information on potential modifications to be made to the intervention, study design, and study process. Trial Registration: ClinicalTrials.gov NCT03282877; https://clinicaltrials.gov/ct2/show/NCT03282877 International Registered Report Identifier (IRRID): DERR1-10.2196/24628 %M 33830058 %R 10.2196/24628 %U https://www.researchprotocols.org/2021/4/e24628 %U https://doi.org/10.2196/24628 %U http://www.ncbi.nlm.nih.gov/pubmed/33830058 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e24170 %T Α Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study %A Hassandra,Mary %A Galanis,Evangelos %A Hatzigeorgiadis,Antonis %A Goudas,Marios %A Mouzakidis,Christos %A Karathanasi,Eleni Maria %A Petridou,Niki %A Tsolaki,Magda %A Zikas,Paul %A Evangelou,Giannis %A Papagiannakis,George %A Bellis,George %A Kokkotis,Christos %A Panagiotopoulos,Spyridon Rafail %A Giakas,Giannis %A Theodorakis,Yannis %+ School of Physical Education, Sport Science and Dietetics, Department of Physical Education and Sport Science, University of Thessaly, Karies, Trikala, 42100, Greece, 30 24310 4700, mxasad@uth.gr %K virtual reality %K elderly %K mild cognitive impairment %K combined physical and cognitive function %K dual task %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Therapeutic virtual reality (VR) has emerged as an effective treatment modality for cognitive and physical training in people with mild cognitive impairment (MCI). However, to replace existing nonpharmaceutical treatment training protocols, VR platforms need significant improvement if they are to appeal to older people with symptoms of cognitive decline and meet their specific needs. Objective: This study aims to design and test the acceptability, usability, and tolerability of an immersive VR platform that allows older people with MCI symptoms to simultaneously practice physical and cognitive skills on a dual task. Methods: On the basis of interviews with 20 older people with MCI symptoms (15 females; mean age 76.25, SD 5.03 years) and inputs from their health care providers (formative study VR1), an interdisciplinary group of experts developed a VR system called VRADA (VR Exercise App for Dementia and Alzheimer’s Patients). Using an identical training protocol, the VRADA system was first tested with a group of 30 university students (16 females; mean age 20.86, SD 1.17 years) and then with 27 older people (19 females; mean age 73.22, SD 9.26 years) who had been diagnosed with MCI (feasibility studies VR2a and VR2b). Those in the latter group attended two Hellenic Association Day Care Centers for Alzheimer’s Disease and Related Disorders. Participants in both groups were asked to perform a dual task training protocol that combined physical and cognitive exercises in two different training conditions. In condition A, participants performed a cycling task in a lab environment while being asked by the researcher to perform oral math calculations (single-digit additions and subtractions). In condition B, participants performed a cycling task in the virtual environment while performing calculations that appeared within the VR app. Participants in both groups were assessed in the same way; this included questionnaires and semistructured interviews immediately after the experiment to capture perceptions of acceptability, usability, and tolerability, and to determine which of the two training conditions each participant preferred. Results: Participants in both groups showed a significant preference for the VR condition (students: mean 0.66, SD 0.41, t29=8.74, P<.001; patients with MCI: mean 0.72, SD 0.51, t26=7.36, P<.001), as well as high acceptance scores for intended future use, attitude toward VR training, and enjoyment. System usability scale scores (82.66 for the students and 77.96 for the older group) were well above the acceptability threshold (75/100). The perceived adverse effects were minimal, indicating a satisfactory tolerability. Conclusions: The findings suggest that VRADA is an acceptable, usable, and tolerable system for physical and cognitive training of older people with MCI and university students. Randomized controlled trial studies are needed to assess the efficacy of VRADA as a tool to promote physical and cognitive health in patients with MCI. %M 33759797 %R 10.2196/24170 %U https://games.jmir.org/2021/1/e24170 %U https://doi.org/10.2196/24170 %U http://www.ncbi.nlm.nih.gov/pubmed/33759797 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e19931 %T Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study %A Wittich,Walter %A Pichora-Fuller,M Kathleen %A Johnson,Aaron %A Joubert,Sven %A Kehayia,Eva %A Bachir,Vanessa %A Aubin,Gabrielle %A Jaiswal,Atul %A Phillips,Natalie %+ School of Optometry, Université de Montréal, 3744, rue Jean-Brillant, room 260-7, Montreal, QC, H3T 1P1, Canada, 1 514 343 7962, walter.wittich@umontreal.ca %K low vision %K rehabilitation %K cognition %K aging %K dementia %K reading %D 2021 %7 11.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer’s disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. Objective: The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. Methods: We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). Results: The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. Conclusions: Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. Trial Registration: ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610 International Registered Report Identifier (IRRID): DERR1-10.2196/19931 %M 33704074 %R 10.2196/19931 %U https://www.researchprotocols.org/2021/3/e19931 %U https://doi.org/10.2196/19931 %U http://www.ncbi.nlm.nih.gov/pubmed/33704074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20298 %T A Risk Prediction Model Based on Machine Learning for Cognitive Impairment Among Chinese Community-Dwelling Elderly People With Normal Cognition: Development and Validation Study %A Hu,Mingyue %A Shu,Xinhui %A Yu,Gang %A Wu,Xinyin %A Välimäki,Maritta %A Feng,Hui %+ Xiangya Nursing School, Central South University, Yuelu District, 172 Tongzipo Road, Changsha , China, 86 15173121969, feng.hui@csu.edu.cn %K prediction model %K cognitive impairment %K machine learning %K nomogram %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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, naïve 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. %M 33625369 %R 10.2196/20298 %U https://www.jmir.org/2021/2/e20298 %U https://doi.org/10.2196/20298 %U http://www.ncbi.nlm.nih.gov/pubmed/33625369 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20177 %T Efficacy of Smart Speaker–Based Metamemory Training in Older Adults: Case-Control Cohort Study %A Kim,Jeongsim %A Shin,EunJi %A Han,KyungHwa %A Park,Soowon %A Youn,Jung Hae %A Jin,Guixiang %A Lee,Jun-Young %+ Department of Psychiatry, Seoul National University College of Medicine and SMG-SNU Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-gu, Seoul, 07061, Republic of Korea, 82 10 9612 0405, benji@snu.ac.kr %K smart speaker %K cognitive training %K cognitive decline %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33591276 %R 10.2196/20177 %U http://www.jmir.org/2021/2/e20177/ %U https://doi.org/10.2196/20177 %U http://www.ncbi.nlm.nih.gov/pubmed/33591276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e14953 %T The Potential for the Internet and Telehealth in Caregiver Support. Comment on “Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention” %A Kajiwara,Kohei %A Kako,Jun %A Noto,Hiroko %A Oosono,Yasufumi %A Kobayashi,Masamitsu %+ Japanese Red Cross Kyushu International College of Nursing, 1-1 Asty Munakata-City, Fukuoka-Prefecture 811-4157, Japan, 81 940 35 7030, k-kajiwara@jrckicn.ac.jp %K dementia %K caregiver %K technology %D 2021 %7 16.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33591281 %R 10.2196/14953 %U https://www.jmir.org/2021/2/e14953 %U https://doi.org/10.2196/14953 %U http://www.ncbi.nlm.nih.gov/pubmed/33591281 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e25340 %T Impacts of Low-cost Robotic Pets for Older Adults and People With Dementia: Scoping Review %A Koh,Wei Qi %A Ang,Faith Xin Hui %A Casey,Dympna %+ National University of Ireland Galway, University Road, Galway, H91TK33, Ireland, 353 91493687, weiqi.koh@nuigalway.ie %K social robot %K assistive technology %K robotic animals %K pet robots %K older adults %K dementia %K low-cost robot %K psychosocial intervention %K intervention %K robot %K review %K intervention %D 2021 %7 12.2.2021 %9 Review %J JMIR Rehabil Assist Technol %G English %X 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. %M 33497349 %R 10.2196/25340 %U http://rehab.jmir.org/2021/1/e25340/ %U https://doi.org/10.2196/25340 %U http://www.ncbi.nlm.nih.gov/pubmed/33497349 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e24965 %T Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral and Psychological Symptoms of Dementia: Interview Study %A Ramirez,Magaly %A Duran,Miriana C %A Pabiniak,Chester J %A Hansen,Kelly E %A Kelley,Ann %A Ralston,James D %A McCurry,Susan M %A Teri,Linda %A Penfold,Robert B %+ Department of Health Services, University of Washington School of Public Health, Hans Rosling Center, 3980 15th Ave NE, Seattle, WA, 98195, United States, 1 5096436227, maggiera@uw.edu %K dementia %K Alzheimer disease %K behavioral symptoms %K caregivers %K internet-based intervention %K education %K behavior %K symptom %K psychology %K qualitative %K caregiver %K intervention %K training %K virtual care %K digital health %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33565984 %R 10.2196/24965 %U http://aging.jmir.org/2021/1/e24965/ %U https://doi.org/10.2196/24965 %U http://www.ncbi.nlm.nih.gov/pubmed/33565984 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e21629 %T Implementations of Evidence-Based eHealth Interventions for Caregivers of People With Dementia in Municipality Contexts (Myinlife and Partner in Balance): Evaluation Study %A Christie,Hannah Liane %A Boots,Lizzy Mitzy Maria %A Tange,Huibert Johannes %A Verhey,Frans Rochus Josef %A de Vugt,Marjolein Elizabeth %+ Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, Maastricht, , Netherlands, 31 045 621 3078, hannah.christie@maastrichtuniversity.nl %K eHealth %K mHealth %K implementation science %K dementia %K caregiving %K municipality %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33544085 %R 10.2196/21629 %U http://aging.jmir.org/2021/1/e21629/ %U https://doi.org/10.2196/21629 %U http://www.ncbi.nlm.nih.gov/pubmed/33544085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26254 %T Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study %A Bacsu,Juanita-Dawne %A O'Connell,Megan E %A Cammer,Allison %A Azizi,Mahsa %A Grewal,Karl %A Poole,Lisa %A Green,Shoshana %A Sivananthan,Saskia %A Spiteri,Raymond J %+ Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 966 2496, megan.oconnell@usask.ca %K Twitter %K social media %K dementia %K COVID-19 %K health policy %K experience %K support %K disorder %K theme %K collaborate %K quality of life %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33468449 %R 10.2196/26254 %U https://www.jmir.org/2021/2/e26254 %U https://doi.org/10.2196/26254 %U http://www.ncbi.nlm.nih.gov/pubmed/33468449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22406 %T 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 %A Appel,Lora %A Kisonas,Erika %A Appel,Eva %A Klein,Jennifer %A Bartlett,Deanna %A Rosenberg,Jarred %A Smith,Christopher NC %+ Faculty of Health, School of Health Policy and Management, York University, 426 Health, Nursing and Environmental Studies Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 6475046537, lora.appel@uhn.ca %K virtual reality %K wearable electronic devices %K sensory art therapies %K hospitalization %K hospitals, community %K hospitals, general %K aged %K humans %K dementia %K behavioral symptoms %K nature %K mobile phone %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X 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° 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. %M 33533720 %R 10.2196/22406 %U https://formative.jmir.org/2021/2/e22406 %U https://doi.org/10.2196/22406 %U http://www.ncbi.nlm.nih.gov/pubmed/33533720 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e23384 %T Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study %A Cyr,Andrée-Ann %A Romero,Kristoffer %A Galin-Corini,Laura %+ Department of Psychology, Glendon Campus, York University, 126 York Hall, 2275 Bayview Avenue, Toronto, ON, M4N 3R4, Canada, 1 416 897 0194, andreeann.cyr@gmail.com %K web-based testing %K aging %K cognition %K neuropsychology %K mobile phone %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33522972 %R 10.2196/23384 %U http://aging.jmir.org/2021/1/e23384/ %U https://doi.org/10.2196/23384 %U http://www.ncbi.nlm.nih.gov/pubmed/33522972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18482 %T Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial %A Gamito,Pedro %A Oliveira,Jorge %A Matias,Marcelo %A Cunha,Elsa %A Brito,Rodrigo %A Lopes,Paulo Ferreira %A Deus,Alberto %+ School of Psychology and Life Sciences, Lusófona University, Campo Grande, 376, Lisboa, 1749-024, Portugal, 351 217515500, jorge.oliveira@ulusofona.pt %K alcohol use disorder %K cognitive training %K virtual reality %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 33512329 %R 10.2196/18482 %U http://www.jmir.org/2021/1/e18482/ %U https://doi.org/10.2196/18482 %U http://www.ncbi.nlm.nih.gov/pubmed/33512329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e14781 %T Development of an Evidence-Based Best Practice Model for Teams Managing Crisis in Dementia: Protocol for a Qualitative Study %A Stanyon,Miriam %A Streater,Amy %A Coleston-Shields,Donna Maria %A Yates,Jennifer %A Challis,David %A Dening,Tom %A Hoe,Juanita %A Lloyd-Evans,Brynmor %A Mitchell,Shirley %A Moniz-Cook,Esme %A Poland,Fiona %A Prothero,David %A Orrell,Martin %+ Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 8230251 ext 30251, miriam.stanyon@nottingham.ac.uk %K dementia %K caregivers %K crisis %K mental health %K home management %D 2021 %7 27.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33502333 %R 10.2196/14781 %U http://www.researchprotocols.org/2021/1/e14781/ %U https://doi.org/10.2196/14781 %U http://www.ncbi.nlm.nih.gov/pubmed/33502333 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19244 %T 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 %A Sturge,Jodi %A Meijering,Louise %A Jones,C Allyson %A Garvelink,Mirjam %A Caron,Danielle %A Nordin,Susanna %A Elf,Marie %A Légaré,France %+ VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Department of Family Medicine and Emergency Medicine, Université Laval, Pavillon Landry-Poulin, door A-1-2, room A-4574, 2525, chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada, 1 418 663 5713, France.Legare@fmed.ulaval.ca %K aging in place %K co-design %K cross-country comparison %K electronic decision support intervention %K housing decisions %K memory problems %K mixed methods %K mobility patterns %K shared decision making %K technology %D 2021 %7 21.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33475512 %R 10.2196/19244 %U http://www.researchprotocols.org/2021/1/e19244/ %U https://doi.org/10.2196/19244 %U http://www.ncbi.nlm.nih.gov/pubmed/33475512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e22831 %T 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 %A Grigorovich,Alisa %A Kulandaivelu,Yalinie %A Newman,Kristine %A Bianchi,Andria %A Khan,Shehroz S %A Iaboni,Andrea %A McMurray,Josephine %+ Lazaridis School of Business & Economics, Wilfred Laurier University, SC Johnston Building, Room 304, 73 George Street, Brantford, ON, N3T 3Y3, Canada, 1 15197568228 ext 5649, jmcmurray@wlu.ca %K assistive technology %K real-time location system %K long-term care %K implementation science %K dementia %K Alzheimer disease %K ambulatory monitoring %K wearable technology %K qualitative research %D 2021 %7 20.1.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 33470949 %R 10.2196/22831 %U http://www.jmir.org/2021/1/e22831/ %U https://doi.org/10.2196/22831 %U http://www.ncbi.nlm.nih.gov/pubmed/33470949 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e25307 %T Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review %A Palmdorf,Sarah %A Stark,Anna Lea %A Nadolny,Stephan %A Eliaß,Gerrit %A Karlheim,Christoph %A Kreisel,Stefan H %A Gruschka,Tristan %A Trompetter,Eva %A Dockweiler,Christoph %+ Centre for ePublic Health Research, School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, 33615, Germany, 49 521106437, christoph.dockweiler@uni-bielefeld.de %K dementia %K home care %K assistive technologies %K scoping review %D 2021 %7 20.1.2021 %9 Review %J JMIR Aging %G English %X 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. %M 33470935 %R 10.2196/25307 %U http://aging.jmir.org/2021/1/e25307/ %U https://doi.org/10.2196/25307 %U http://www.ncbi.nlm.nih.gov/pubmed/33470935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22463 %T 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 %A Ahmed,Mona %A Marín,Mayca %A Bouça-Machado,Raquel %A How,Daniella %A Judica,Elda %A Tropea,Peppino %A Bentlage,Ellen %A Brach,Michael %+ Institute of Sport and Exercise Sciences, Münster University, Horstmarer Landweg 62b, Münster, 48149, Germany, 49 251 83 ext 34889, mona.ahmad@uni-muenster.de %K dementia %K older adults %K neurodegenerative diseases %K integrated care %K health care technologies %K user-centered design %D 2021 %7 12.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33433394 %R 10.2196/22463 %U https://www.researchprotocols.org/2021/1/e22463 %U https://doi.org/10.2196/22463 %U http://www.ncbi.nlm.nih.gov/pubmed/33433394 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25144 %T Repeated Transcranial Magnetic Stimulation for Improving Cognition in Patients With Alzheimer Disease: Protocol for a Randomized, Double-Blind, Placebo-Controlled Trial %A Moussavi,Zahra %A Rutherford,Grant %A Lithgow,Brian %A Millikin,Colleen %A Modirrousta,Mandana %A Mansouri,Behzad %A Wang,Xikui %A Omelan,Craig %A Fellows,Lesley %A Fitzgerald,Paul %A Koski,Lisa %+ Biomedical Engineering Program, The University of Manitoba, 75 Chancellor Circle, E2-390 Engineering Complex, Winnipeg, MB, R3T5V6, Canada, 1 204 474 7023, Zahra.Moussavi@umanitoba.ca %K repetitive transcranial magnetic stimulation %K Alzheimer disease %K double blind %K treatment %K placebo controlled %K randomized %D 2021 %7 8.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33416500 %R 10.2196/25144 %U http://www.researchprotocols.org/2021/1/e25144/ %U https://doi.org/10.2196/25144 %U http://www.ncbi.nlm.nih.gov/pubmed/33416500 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e20225 %T Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study %A Rivera-Rodriguez,Claudia %A Cheung,Gary %A Cullum,Sarah %+ Department of Statistics, University of Auckland, 2/1576 Great North Road, Waterview, Auckland, 1026, New Zealand, 64 0223920565, c.rodriguez@auckland.ac.nz %K routinely collected data %K repeated measures %K dementia %K Alzheimer disease %K modeling %K complex sampling   %D 2021 %7 6.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33404510 %R 10.2196/20225 %U https://www.researchprotocols.org/2021/1/e20225 %U https://doi.org/10.2196/20225 %U http://www.ncbi.nlm.nih.gov/pubmed/33404510 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25351 %T Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study %A Mace,Ryan A %A Doorley,James D %A Popok,Paula J %A Vranceanu,Ana-Maria %+ Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Sq, 1st floor, Suite 100, Boston, MA, 02114, United States, 1 617 724 4977, avranceanu@mgh.harvard.edu %K chronic pain %K cognitive decline %K physical activity %K mind-body therapies %K aged %K telemedicine %K mobile phone %D 2021 %7 4.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33208301 %R 10.2196/25351 %U https://www.researchprotocols.org/2021/1/e25351 %U https://doi.org/10.2196/25351 %U http://www.ncbi.nlm.nih.gov/pubmed/33208301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e17332 %T Electronic Cognitive Screen Technology for Screening Older Adults With Dementia and Mild Cognitive Impairment in a Community Setting: Development and Validation Study %A Chan,Joyce Y C %A Wong,Adrian %A Yiu,Brian %A Mok,Hazel %A Lam,Patti %A Kwan,Pauline %A Chan,Amany %A Mok,Vincent C T %A Tsoi,Kelvin K F %A Kwok,Timothy C Y %+ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F., Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, N.T., Hong Kong, 852, Hong Kong, 852 3505 3145, tkwok@cuhk.edu.hk %K EC-Screen %K cognitive screening %K dementia %K mild cognitive impairment %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33337341 %R 10.2196/17332 %U http://www.jmir.org/2020/12/e17332/ %U https://doi.org/10.2196/17332 %U http://www.ncbi.nlm.nih.gov/pubmed/33337341 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e23904 %T A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians %A Levinson,Anthony J %A Bousfield,John %A Douglas,William %A Ayers,Stephanie %A Sztramko,Richard %+ Division of e-Learning Innovation, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22210, levinsa@mcmaster.ca %K dementia %K caregiver %K education prescription %K online education %K internet %K eHealth %K knowledge translation %K implementation science %K scale and spread %D 2020 %7 4.12.2020 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 33275103 %R 10.2196/23904 %U http://humanfactors.jmir.org/2020/4/e23904/ %U https://doi.org/10.2196/23904 %U http://www.ncbi.nlm.nih.gov/pubmed/33275103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e17531 %T Involvement of People With Dementia in the Development of Technology-Based Interventions: Narrative Synthesis Review and Best Practice Guidelines %A Rai,Harleen Kaur %A Cavalcanti Barroso,Aline %A Yates,Lauren %A Schneider,Justine %A Orrell,Martin %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 01157484252, Harleen.Rai@nottingham.ac.uk %K dementia %K technology %K co-production %K participation %K development %D 2020 %7 3.12.2020 %9 Review %J J Med Internet Res %G English %X 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. %M 33270034 %R 10.2196/17531 %U https://www.jmir.org/2020/12/e17531 %U https://doi.org/10.2196/17531 %U http://www.ncbi.nlm.nih.gov/pubmed/33270034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e20430 %T Assessing the Effect of Training on the Cognition and Brain of Older Adults: Protocol for a Three-Arm Randomized Double-Blind Controlled Trial (ACTOP) %A Boujut,Arnaud %A Mellah,Samira %A Lussier,Maxime %A Maltezos,Samantha %A Verty,Lynn Valeyry %A Bherer,Louis %A Belleville,Sylvie %+ Research Center, Institut universitaire de Gériatrie de Montréal, 4565, Queen-Mary Rd, Montréal, QC, H3W 1W5, Canada, 1 514 340 3540 ext 4767, sylvie.belleville@umontreal.ca %K cognitive training %K working memory %K brain plasticity %K aging %K cognitive reserve %D 2020 %7 24.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33231556 %R 10.2196/20430 %U http://www.researchprotocols.org/2020/11/e20430/ %U https://doi.org/10.2196/20430 %U http://www.ncbi.nlm.nih.gov/pubmed/33231556 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e17105 %T An Individual Cognitive Stimulation Therapy App for People With Dementia: Development and Usability Study of Thinkability %A Rai,Harleen Kaur %A Schneider,Justine %A Orrell,Martin %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 748 4252, Harleen.Rai@nottingham.ac.uk %K dementia %K cognitive stimulation therapy %K eHealth %K development %D 2020 %7 16.11.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33196451 %R 10.2196/17105 %U http://aging.jmir.org/2020/2/e17105/ %U https://doi.org/10.2196/17105 %U http://www.ncbi.nlm.nih.gov/pubmed/33196451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20840 %T Use of Patient-Reported Symptoms from an Online Symptom Tracking Tool for Dementia Severity Staging: Development and Validation of a Machine Learning Approach %A Shehzad,Aaqib %A Rockwood,Kenneth %A Stanley,Justin %A Dunn,Taylor %A Howlett,Susan E %+ Geriatric Medicine Research Unit, Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E9, Canada, 1 9024738687, research@dgiclinical.com %K dementia stage %K Alzheimer disease %K mild cognitive impairment %K machine learning %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SymptomGuide Dementia (DGI Clinical Inc) is a publicly available online symptom tracking tool to support caregivers of persons living with dementia. The value of such data are enhanced when the specific dementia stage is identified. Objective: We aimed to develop a supervised machine learning algorithm to classify dementia stages based on tracked symptoms. Methods: We employed clinical data from 717 people from 3 sources: (1) a memory clinic; (2) long-term care; and (3) an open-label trial of donepezil in vascular and mixed dementia (VASPECT). Symptoms were captured with SymptomGuide Dementia. A clinician classified participants into 4 groups using either the Functional Assessment Staging Test or the Global Deterioration Scale as mild cognitive impairment, mild dementia, moderate dementia, or severe dementia. Individualized symptom profiles from the pooled data were used to train machine learning models to predict dementia severity. Models trained with 6 different machine learning algorithms were compared using nested cross-validation to identify the best performing model. Model performance was assessed using measures of balanced accuracy, precision, recall, Cohen κ, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). The best performing algorithm was used to train a model optimized for balanced accuracy. Results: The study population was mostly female (424/717, 59.1%), older adults (mean 77.3 years, SD 10.6, range 40-100) with mild to moderate dementia (332/717, 46.3%). Age, duration of symptoms, 37 unique dementia symptoms, and 10 symptom-derived variables were used to distinguish dementia stages. A model trained with a support vector machine learning algorithm using a one-versus-rest approach showed the best performance. The correct dementia stage was identified with 83% balanced accuracy (Cohen κ=0.81, AUPRC 0.91, AUROC 0.96). The best performance was seen when classifying severe dementia (AUROC 0.99). Conclusions: A supervised machine learning algorithm exhibited excellent performance in identifying dementia stages based on dementia symptoms reported in an online environment. This novel dementia staging algorithm can be used to describe dementia stage based on user-reported symptoms. This type of symptom recording offers real-world data that reflect important symptoms in people with dementia. %M 33174853 %R 10.2196/20840 %U http://www.jmir.org/2020/11/e20840/ %U https://doi.org/10.2196/20840 %U http://www.ncbi.nlm.nih.gov/pubmed/33174853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17720 %T Identifying the Value of an eHealth Intervention Aimed at Cognitive Impairments: Observational Study in Different Contexts and Service Models %A Jurkeviciute,Monika %A van Velsen,Lex %A Eriksson,Henrik %A Lifvergren,Svante %A Trimarchi,Pietro Davide %A Andin,Ulla %A Svensson,Johan %+ Centre for Healthcare Improvement, Chalmers University of Technology, Vera Sandbergs Allé 8, Gothenburg, 41296, Sweden, 46 766061558, monika.jurkeviciute@chalmers.se %K eHealth value %K evaluation of value %K eHealth intervention %K cognitive impairment %K role of context %K cost benefit %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33064089 %R 10.2196/17720 %U http://www.jmir.org/2020/10/e17720/ %U https://doi.org/10.2196/17720 %U http://www.ncbi.nlm.nih.gov/pubmed/33064089 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e19852 %T Smartphone-Based Experience Sampling in People With Mild Cognitive Impairment: Feasibility and Usability Study %A Bartels,Sara Laureen %A van Knippenberg,Rosalia J M %A Malinowsky,Camilla %A Verhey,Frans R J %A de Vugt,Marjolein E %+ Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Dr. Tanslaan 12, Nivo 4, Maastricht, 6229 ET, Netherlands, 31 387 41 75, sara.bartels@maastrichtuniversity.nl %K experience sampling method %K mild cognitive impairment %K cognition %K feasibility %K smartphones %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33064084 %R 10.2196/19852 %U http://aging.jmir.org/2020/2/e19852/ %U https://doi.org/10.2196/19852 %U http://www.ncbi.nlm.nih.gov/pubmed/33064084 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e18971 %T AQUEDUCT Intervention for Crisis Team Quality and Effectiveness in Dementia: Protocol for a Feasibility Study %A Broome,Emma Elizabeth %A Coleston-Shields,Donna Maria %A Dening,Tom %A Moniz-Cook,Esme %A Poland,Fiona %A Stanyon,Miriam %A Orrell,Martin %+ National Institute for Health Research Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham, NG15DU, United Kingdom, 44 115 919 4488, emma.broome1@nottingham.ac.uk %K dementia %K crisis %K mental health %K community services %K feasibility study %D 2020 %7 13.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33048059 %R 10.2196/18971 %U http://www.researchprotocols.org/2020/10/e18971/ %U https://doi.org/10.2196/18971 %U http://www.ncbi.nlm.nih.gov/pubmed/33048059 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e18455 %T Effect of Spatial Disorientation in a Virtual Environment on Gait and Vital Features in Patients with Dementia: Pilot Single-Blind Randomized Control Trial %A Amaefule,Chimezie O %A Lüdtke,Stefan %A Kirste,Thomas %A Teipel,Stefan J %+ German Center for Neurodegenerative Diseases (DZNE), Gehlsheimer Strasse 20, Rostock, 18147, Germany, 49 381 494 9478, chimezie.amaefule@dzne.de %K spatial disorientation %K activity recognition %K wayfinding %K wearable sensors %K dementia %K virtual reality %K older adults %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Serious Games %G English %X 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 %M 33030436 %R 10.2196/18455 %U https://games.jmir.org/2020/4/e18455 %U https://doi.org/10.2196/18455 %U http://www.ncbi.nlm.nih.gov/pubmed/33030436 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e21264 %T Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education From the Clinician’s Perspective: Qualitative Study %A Levinson,Anthony J %A Ayers,Stephanie %A Butler,Lianna %A Papaioannou,Alexandra %A Marr,Sharon %A Sztramko,Richard %+ Division of e-Learning Innovation, McMaster University, 1280 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140 ext 26525, levinsa@mcmaster.ca %K dementia %K caregiver %K online education %K implementation science %K internet %K eHealth %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 33006563 %R 10.2196/21264 %U http://aging.jmir.org/2020/2/e21264/ %U https://doi.org/10.2196/21264 %U http://www.ncbi.nlm.nih.gov/pubmed/33006563 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19880 %T A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders %A Frost,Emily %A Porat,Talya %A Malhotra,Paresh %A Picinali,Lorenzo %+ Dyson School of Design Engineering, Imperial College London, Dyson Building, Imperial College Road, London, SW7 2DB, United Kingdom, 44 2075948158, e.frost@imperial.ac.uk %K cognitive decline %K mobile phone %K hearing loss %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 32996884 %R 10.2196/19880 %U http://humanfactors.jmir.org/2020/3/e19880/ %U https://doi.org/10.2196/19880 %U http://www.ncbi.nlm.nih.gov/pubmed/32996884 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e21881 %T Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study %A Wilson,Rozanne %A Small,Jeff %+ School of Audiology and Speech Sciences, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 6044407540, r.wilson@audiospeech.ubc.ca %K mobile apps %K mobile phone %K caregivers %K dementia %K communication %K patient care %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Nursing %G English %X 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. %M 34406973 %R 10.2196/21881 %U https://nursing.jmir.org/2020/1/e21881/ %U https://doi.org/10.2196/21881 %U http://www.ncbi.nlm.nih.gov/pubmed/34406973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19431 %T 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 %A Anstey,Kaarin J %A Cherbuin,Nicolas %A Kim,Sarang %A McMaster,Mitchell %A D'Este,Catherine %A Lautenschlager,Nicola %A Rebok,George %A McRae,Ian %A Torres,Susan J %A Cox,Kay L %A Pond,Constance Dimity %+ School of Psychology, University of New South Wales, Matthews Building, Kensington, Sydney, 2031, Australia, 61 412935746, k.anstey@unsw.edu.au %K risk reduction behavior %K dementia prevention & control %K primary prevention %K pragmatic clinical trial %K prevention %K primary care %D 2020 %7 24.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32969833 %R 10.2196/19431 %U http://www.jmir.org/2020/9/e19431/ %U https://doi.org/10.2196/19431 %U http://www.ncbi.nlm.nih.gov/pubmed/32969833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e19579 %T Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study %A Campbell,Laura M %A Paolillo,Emily W %A Heaton,Anne %A Tang,Bin %A Depp,Colin A %A Granholm,Eric %A Heaton,Robert K %A Swendsen,Joel %A Moore,David J %A Moore,Raeanne C %+ Department of Psychiatry, University of California San Diego, 220 Dickinson St. Suite B (8231), San Diego, CA, 92103-8231, United States, 1 6195435378, r6moore@ucsd.edu %K ecological momentary assessment %K daily functioning %K telemedicine %K digital health %K neuropsychological test %K cognition %K HIV %K aging %K mobile phone %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 (β=−1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.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 (β=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.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. %M 32969829 %R 10.2196/19579 %U http://mhealth.jmir.org/2020/9/e19579/ %U https://doi.org/10.2196/19579 %U http://www.ncbi.nlm.nih.gov/pubmed/32969829 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18234 %T A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test %A Middleton,Rod M %A Pearson,Owen R %A Ingram,Gillian %A Craig,Elaine M %A Rodgers,William J %A Downing-Wood,Hannah %A Hill,Joseph %A Tuite-Dalton,Katherine %A Roberts,Christopher %A Watson,Lynne %A Ford,David V %A Nicholas,Richard %A , %+ Population Data Science, Swansea University Medical School, Swansea University, Data Science Building, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792606760, r.m.middleton@swansea.ac.uk %K cognition %K multiple sclerosis %K eHealth %K electronic assessment %K patient reported outcomes %K neurology %D 2020 %7 23.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32965240 %R 10.2196/18234 %U http://www.jmir.org/2020/9/e18234/ %U https://doi.org/10.2196/18234 %U http://www.ncbi.nlm.nih.gov/pubmed/32965240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19897 %T A Personalized Voice-Based Diet Assistant for Caregivers of Alzheimer Disease and Related Dementias: System Development and Validation %A Li,Juan %A Maharjan,Bikesh %A Xie,Bo %A Tao,Cui %+ University of Texas Health Science Center at Houston, 7000 Fannin Street Suite 600, Houston, TX, 77030, United States, 1 7135003981, cui.tao@uth.tmc.edu %K Alzheimer disease %K dementia %K diet %K knowledge %K ontology %K voice assistant %D 2020 %7 21.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32955452 %R 10.2196/19897 %U http://www.jmir.org/2020/9/e19897/ %U https://doi.org/10.2196/19897 %U http://www.ncbi.nlm.nih.gov/pubmed/32955452 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17963 %T Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study %A Lunardini,Francesca %A Luperto,Matteo %A Romeo,Marta %A Basilico,Nicola %A Daniele,Katia %A Azzolino,Domenico %A Damanti,Sarah %A Abbate,Carlo %A Mari,Daniela %A Cesari,Matteo %A Borghese,Nunzio Alberto %A Ferrante,Simona %+ Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Giuseppe Colombo 40, Milano, 20133, Italy, 39 3334335004, francesca.lunardini@polimi.it %K aging %K Bells Test %K computerized testing %K dementia %K early diagnosis %K eHealth %K mild cognitive impairment %K neuropsychological assessment %K Trail Making Test %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32955442 %R 10.2196/17963 %U http://mhealth.jmir.org/2020/9/e17963/ %U https://doi.org/10.2196/17963 %U http://www.ncbi.nlm.nih.gov/pubmed/32955442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18209 %T 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 %A Dove,Erica %A Wang,Rosalie %A Zabjek,Karl %A Astell,Arlene %+ Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, , Canada, 1 4165973422 ext 7842, erica.dove@mail.utoronto.ca %K motion-based technology %K dementia %K mild cognitive impairment %K cognitive dysfunction %K postural balance %K movement confidence %K cognition %K exercise movement techniques %D 2020 %7 18.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32945780 %R 10.2196/18209 %U http://www.researchprotocols.org/2020/9/e18209/ %U https://doi.org/10.2196/18209 %U http://www.ncbi.nlm.nih.gov/pubmed/32945780 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e20995 %T Identifying Key Predictors of Cognitive Dysfunction in Older People Using Supervised Machine Learning Techniques: Observational Study %A Rankin,Debbie %A Black,Michaela %A Flanagan,Bronac %A Hughes,Catherine F %A Moore,Adrian %A Hoey,Leane %A Wallace,Jonathan %A Gill,Chris %A Carlin,Paul %A Molloy,Anne M %A Cunningham,Conal %A McNulty,Helene %+ School of Computing, Engineering and Intelligent Systems, Ulster University, Northland Road, Derry~Londonderry, BT48 7JL, United Kingdom, 44 287167 ext 5841, d.rankin1@ulster.ac.uk %K classification %K supervised machine learning %K cognition %K diet %K aging %K geriatric assessment %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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, Naïve 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. %M 32936084 %R 10.2196/20995 %U http://medinform.jmir.org/2020/9/e20995/ %U https://doi.org/10.2196/20995 %U http://www.ncbi.nlm.nih.gov/pubmed/32936084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19133 %T Social Reminiscence in Older Adults’ Everyday Conversations: Automated Detection Using Natural Language Processing and Machine Learning %A Ferrario,Andrea %A Demiray,Burcu %A Yordanova,Kristina %A Luo,Minxia %A Martin,Mike %+ Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 86 24, aferrario@ethz.ch %K aging %K dementia %K reminiscence %K real-life conversations %K electronically activated recorder (EAR) %K natural language processing %K machine learning %K imbalanced learning %D 2020 %7 15.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32866108 %R 10.2196/19133 %U http://www.jmir.org/2020/9/e19133/ %U https://doi.org/10.2196/19133 %U http://www.ncbi.nlm.nih.gov/pubmed/32866108 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19468 %T Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis %A Leng,Minmin %A Zhao,Yajie %A Xiao,Hongmei %A Li,Ce %A Wang,Zhiwen %+ School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 15901566817, wzwjing@sina.com %K family caregivers %K dementia %K supportive interventions %K internet %K systematic review %D 2020 %7 9.9.2020 %9 Review %J J Med Internet Res %G English %X 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 %M 32902388 %R 10.2196/19468 %U http://www.jmir.org/2020/9/e19468/ %U https://doi.org/10.2196/19468 %U http://www.ncbi.nlm.nih.gov/pubmed/32902388 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e19870 %T Using Dual Neural Network Architecture to Detect the Risk of Dementia With Community Health Data: Algorithm Development and Validation Study %A Shen,Xiao %A Wang,Guanjin %A Kwan,Rick Yiu-Cho %A Choi,Kup-Sze %+ Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, 852 3400 3214, hskschoi@polyu.edu.hk %K cognitive screening %K dementia risk %K dual neural network %K predictive models %K primary care %D 2020 %7 31.8.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32865498 %R 10.2196/19870 %U https://medinform.jmir.org/2020/8/e19870 %U https://doi.org/10.2196/19870 %U http://www.ncbi.nlm.nih.gov/pubmed/32865498 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e19495 %T Motion-Based Technology for People With Dementia Training at Home: Three-Phase Pilot Study Assessing Feasibility and Efficacy %A Petersen,Jindong Ding %A Larsen,Eva Ladekjær %A la Cour,Karen %A von Bülow,Cecilie %A Skouboe,Malene %A Christensen,Jeanette Reffstrup %A Waldorff,Frans Boch %+ Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J B Winsløws Vej 9, Odense, Denmark, 45 29367599, jindong@health.sdu.dk %K dementia %K motion-based technology %K virtual reality %K telerehabilitation %K physical training %K physical and mental function %D 2020 %7 26.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 32845243 %R 10.2196/19495 %U http://mental.jmir.org/2020/8/e19495/ %U https://doi.org/10.2196/19495 %U http://www.ncbi.nlm.nih.gov/pubmed/32845243 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e18189 %T Artificial Intelligence for Caregivers of Persons With Alzheimer’s Disease and Related Dementias: Systematic Literature Review %A Xie,Bo %A Tao,Cui %A Li,Juan %A Hilsabeck,Robin C %A Aguirre,Alyssa %+ School of Nursing, The University of Texas at Austin, 1710 Red River, Austin, TX, 78712, United States, 1 512 232 5788, boxie@utexas.edu %K Alzheimer disease %K dementia %K caregiving %K technology %K artificial intelligence %D 2020 %7 20.8.2020 %9 Review %J JMIR Med Inform %G English %X 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. %M 32663146 %R 10.2196/18189 %U http://medinform.jmir.org/2020/8/e18189/ %U https://doi.org/10.2196/18189 %U http://www.ncbi.nlm.nih.gov/pubmed/32663146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17406 %T 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 %A Bogza,Laura-Mihaela %A Patry-Lebeau,Cassandra %A Farmanova,Elina %A Witteman,Holly O %A Elliott,Jacobi %A Stolee,Paul %A Hudon,Carol %A Giguere,Anik M C %+ Laval University Research Centre on Community-Based Primary Health Care, Pavillon Landry-Poulin, Door #A-1-2, Office #2416, 2525 Chemin de la Canardière, Quebec, QC, G1J 0A4, Canada, 1 4188214123, anik.giguere@fmed.ulaval.ca %K decision aid %K mild cognitive impairment %K elderly %K decision support technique %K aging %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32442151 %R 10.2196/17406 %U https://www.jmir.org/2020/8/e17406 %U https://doi.org/10.2196/17406 %U http://www.ncbi.nlm.nih.gov/pubmed/32442151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18136 %T 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 %A Kim,Ko Woon %A Lee,Sung Yun %A Choi,Jongdoo %A Chin,Juhee %A Lee,Byung Hwa %A Na,Duk L %A Choi,Jee Hyun %+ Center for Neuroscience, Korea Institute of Science and Technology, Hwarang-ro 14-gil 5, Seongbuk-gu, Seoul, 02792, Republic of Korea, 82 29586952, jeechoi@kist.re.kr %K alzheimer disease %K Rey-Osterrieth Complex Figure %K digital biomarkers %K copying process %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32491988 %R 10.2196/18136 %U https://www.jmir.org/2020/8/e18136 %U https://doi.org/10.2196/18136 %U http://www.ncbi.nlm.nih.gov/pubmed/32491988 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e16089 %T 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 %A Piano,Marianne %A Nilforooshan,Ramin %A Evans,Simon %+ School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Elizabeth Fry Building, Guildford, GU2 7XH, United Kingdom, 44 1483686000 ext 6945, simon.evans@surrey.ac.uk %K binocular vision %K dementia %K magnetic resonance imaging %K stereopsis %K pupil %K sleep %D 2020 %7 10.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32773379 %R 10.2196/16089 %U https://www.researchprotocols.org/2020/8/e16089 %U https://doi.org/10.2196/16089 %U http://www.ncbi.nlm.nih.gov/pubmed/32773379 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e17565 %T User Experience of Interactive Technologies for People With Dementia: Comparative Observational Study %A Andrade Ferreira,Luis Duarte %A Ferreira,Henrique %A Cavaco,Sofia %A Cameirão,Mónica %A i Badia,Sergi Bermúdez %+ NOVA LINCS, Dep de Informática, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Campus de Caparica, Caparica, Lisboa, 2829-516, Portugal, 351 21 294 8300, luis.d.ferreira@m-iti.org %K dementia %K technology %K interaction %K psychomotor performance %K equipment safety %K costs and cost analysis %K user-computer interface %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 32755894 %R 10.2196/17565 %U http://games.jmir.org/2020/3/e17565/ %U https://doi.org/10.2196/17565 %U http://www.ncbi.nlm.nih.gov/pubmed/32755894 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e16180 %T Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov %A Minen,Mia Tova %A Reichel,Julia Frederica %A Pemmireddy,Pallavi %A Loder,Elizabeth %A Torous,John %+ NYU Langone Health, 222 E 41st Street,, New York, NY, 10017, United States, 1 2122637744, minenmd@gmail.com %K smartphones %K mobile phones %K apps %K mental health %K regulation %K stroke %K migraine %K major depressive disorder %K Alzheimer disease %K anxiety disorders %K alcohol use disorders %K opioid use disorders %K epilepsy %K schizophrenia %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32749230 %R 10.2196/16180 %U https://mhealth.jmir.org/2020/8/e16180 %U https://doi.org/10.2196/16180 %U http://www.ncbi.nlm.nih.gov/pubmed/32749230 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e18389 %T Analysis of Benzodiazepine Prescription Practices in Elderly Appalachians with Dementia via the Appalachian Informatics Platform: Longitudinal Study %A Bhardwaj,Niharika %A Cecchetti,Alfred A %A Murughiyan,Usha %A Neitch,Shirley %+ Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, 1600 Medical Center Drive, Suite 265, Huntington, WV, 25701, United States, 1 304 691 5397, bhardwaj1@marshall.edu %K dementia %K Alzheimer disease %K benzodiazepines %K Appalachia %K geriatrics %K informatics platform %K interactive visualization %K eHealth %K clinical data %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32749226 %R 10.2196/18389 %U https://medinform.jmir.org/2020/8/e18389 %U https://doi.org/10.2196/18389 %U http://www.ncbi.nlm.nih.gov/pubmed/32749226 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16928 %T Perceived Need and Acceptability of an App to Support Activities of Daily Living in People With Cognitive Impairment and Their Carers: Pilot Survey Study %A Lai,Rhoda %A Tensil,Maria %A Kurz,Alexander %A Lautenschlager,Nicola T %A Diehl-Schmid,Janine %+ Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Str 22, Munich, 81675, Germany, 49 89 41406488, janine.diehl-schmid@tum.de %K Aged %K dementia %K memory disorders %K carers %K mobile apps %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32735223 %R 10.2196/16928 %U http://mhealth.jmir.org/2020/7/e16928/ %U https://doi.org/10.2196/16928 %U http://www.ncbi.nlm.nih.gov/pubmed/32735223 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16596 %T Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick YC %A Lee,Deborah %A Lee,Paul H %A Tse,Mimi %A Cheung,Daphne SK %A Thiamwong,Ladda %A Choi,Kup-Sze %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Hong Kong (China), 852 27666546 ext 6546, rick.kwan@polyu.edu.hk %K cognitive frailty %K brisk walking %K smartphone %K moderate-to-vigorous physical activity %K older people %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 32735218 %R 10.2196/16596 %U https://mhealth.jmir.org/2020/7/e16596 %U https://doi.org/10.2196/16596 %U http://www.ncbi.nlm.nih.gov/pubmed/32735218 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e14637 %T Prevalence of Mental Disorders, Cognitive Impairment, and Dementia Among Older Adults in Egypt: Protocol for a Systematic Review %A Odejimi,Opeyemi %A Tadros,George %A Sabry,Noha %+ Psychiatric Liaison Department, Birmingham and Solihull Mental Health Foundation Trust, B1, 50 Summer Hill Rd, Birmingham, B1 3RD, United Kingdom, 44 7896535897, ope.odejimi@nhs.net %K mental disorders %K cognitive impairment %K dementia %K older adults %K Egypt %K prevalence %K socio-demographic factors %K systematic review %K protocol %D 2020 %7 24.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32706699 %R 10.2196/14637 %U http://www.researchprotocols.org/2020/7/e14637/ %U https://doi.org/10.2196/14637 %U http://www.ncbi.nlm.nih.gov/pubmed/32706699 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e15600 %T A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study %A Guisado-Fernandez,Estefania %A Blake,Catherine %A Mackey,Laura %A Silva,Paula Alexandra %A Power,Dermot %A O'Shea,Diarmuid %A Caulfield,Brian %+ Insight Centre for Data Analytics, O'Brien Science Building East, Belfield Campus, University College Dublin, Dublin, D04 N2E5, Ireland, 353 0838345003, estefaniaguisadofernandez@gmail.com %K Connected Health %K dementia %K informal caregiver %K home care %K home monitoring %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Aging %G English %X 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 %M 32706650 %R 10.2196/15600 %U http://aging.jmir.org/2020/2/e15600/ %U https://doi.org/10.2196/15600 %U http://www.ncbi.nlm.nih.gov/pubmed/32706650 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17851 %T Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry %A Du,Yan %A Paiva,Kristi %A Cebula,Adrian %A Kim,Seon %A Lopez,Katrina %A Li,Chengdong %A White,Carole %A Myneni,Sahiti %A Seshadri,Sudha %A Wang,Jing %+ Center on Smart and Connected Health Technologies, School of Nursing, The University of Texas Health Science Center at San Antonio, 7739 Floyd Drive, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K diabetes %K Alzheimer disease %K dementia %K caregivers %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32628119 %R 10.2196/17851 %U http://www.jmir.org/2020/7/e17851/ %U https://doi.org/10.2196/17851 %U http://www.ncbi.nlm.nih.gov/pubmed/32628119 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17120 %T Ecological Momentary Assessment Within a Digital Health Intervention for Reminiscence in Persons With Dementia and Caregivers: User Engagement Study %A Potts,Courtney %A Bond,Raymond %A Ryan,Assumpta %A Mulvenna,Maurice %A McCauley,Claire %A Laird,Elizabeth %A Goode,Deborah %+ Ulster University, School of Computing, Shore Road, Jordanstown, United Kingdom, 44 28 9036 8602, md.mulvenna@ulster.ac.uk %K ecological momentary assessment %K EMA %K app %K behaviour analytics %K event logging %K dementia %K carers %K reminiscence %K reminiscing %K mHealth %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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%; χ21=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. %M 32420890 %R 10.2196/17120 %U https://mhealth.jmir.org/2020/7/e17120 %U https://doi.org/10.2196/17120 %U http://www.ncbi.nlm.nih.gov/pubmed/32420890 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16841 %T Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review %A Zhao,Yinan %A Feng,Hui %A Wu,Xinyin %A Du,Yan %A Yang,Xiufen %A Hu,Mingyue %A Ning,Hongting %A Liao,Lulu %A Chen,Huijing %A Zhao,Yishan %+ Xiangya School of Nursing, Central South University, No. 172 Tongzipo Road, Changsha, China, 86 82650292, feng.hui@csu.edu.cn %K mild cognitive impairment %K dementia %K exergaming %K physical %K cognitive %D 2020 %7 30.6.2020 %9 Review %J JMIR Serious Games %G English %X 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. %M 32602841 %R 10.2196/16841 %U http://games.jmir.org/2020/2/e16841/ %U https://doi.org/10.2196/16841 %U http://www.ncbi.nlm.nih.gov/pubmed/32602841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17632 %T Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study %A Saredakis,Dimitrios %A Keage,Hannah AD %A Corlis,Megan %A Loetscher,Tobias %+ University of South Australia, St Bernards Road, Magill, South Australia, Adelaide, 5072, Australia, 61 08 8302 4083, dimitrios.saredakis@mymail.unisa.edu.au %K reminiscence %K head-mounted display %K apathy %K cognitive aging %K dementia %K residential facilities %K virtual reality %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32469314 %R 10.2196/17632 %U http://www.jmir.org/2020/6/e17632/ %U https://doi.org/10.2196/17632 %U http://www.ncbi.nlm.nih.gov/pubmed/32469314 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17769 %T 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 %A Peterson,Colleen M %A Mikal,Jude P %A McCarron,Hayley R %A Finlay,Jessica M %A Mitchell,Lauren L %A Gaugler,Joseph E %+ Division of Health Policy & Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 612 626 2485, gaug0015@umn.edu %K Alzheimer disease %K technology %K disease management %K personal health record %K family caregiving %K informal caregiving %K caregiver burnout %K web-based intervention %K assistive technology %D 2020 %7 26.6.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 32589158 %R 10.2196/17769 %U http://aging.jmir.org/2020/1/e17769/ %U https://doi.org/10.2196/17769 %U http://www.ncbi.nlm.nih.gov/pubmed/32589158 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e18624 %T Developing a Plan for the Sustainable Implementation of an Electronic Health Intervention (Partner in Balance) to Support Caregivers of People With Dementia: Case Study %A Christie,Hannah Liane %A Boots,Lizzy Mitzy Maria %A Peetoom,Kirsten %A Tange,Huibert Johannes %A Verhey,Frans Rochus Josef %A de Vugt,Marjolein Elizabeth %+ Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Universiteit Maastricht, Postbus 616, Maastricht, 6200 MD, Netherlands, 32 0456213078, hannah.christie@maastrichtuniversity.nl %K dementia %K caregiving %K eHealth %K implementation %K business modeling %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 32584261 %R 10.2196/18624 %U http://aging.jmir.org/2020/1/e18624/ %U https://doi.org/10.2196/18624 %U http://www.ncbi.nlm.nih.gov/pubmed/32584261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16371 %T Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study %A Seelye,Adriana %A Leese,Mira Isabelle %A Dorociak,Katherine %A Bouranis,Nicole %A Mattek,Nora %A Sharma,Nicole %A Beattie,Zachary %A Riley,Thomas %A Lee,Jonathan %A Cosgrove,Kevin %A Fleming,Nicole %A Klinger,Jessica %A Ferguson,John %A Lamberty,Greg John %A Kaye,Jeffrey %+ Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN, , United States, 1 6127252000, adriana.seelye@va.gov %K aging %K mild cognitive impairment %K activities of daily living %K technology %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32310138 %R 10.2196/16371 %U https://formative.jmir.org/2020/6/e16371 %U https://doi.org/10.2196/16371 %U http://www.ncbi.nlm.nih.gov/pubmed/32310138 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e17819 %T Predicting Onset of Dementia Using Clinical Notes and Machine Learning: Case-Control Study %A Hane,Christopher A %A Nori,Vijay S %A Crown,William H %A Sanghavi,Darshak M %A Bleicher,Paul %+ OptumLabs, Optum, 1 Main St, 10th Floor, Cambridge, MA, 02142, United States, 1 6126326432, christopher.hane@optum.com %K Alzheimer disease %K dementia %K health information systems %K machine learning %K natural language processing %K health information interoperability %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32490841 %R 10.2196/17819 %U https://medinform.jmir.org/2020/6/e17819 %U https://doi.org/10.2196/17819 %U http://www.ncbi.nlm.nih.gov/pubmed/32490841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16772 %T Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial %A Chan,Windy SY %A Leung,Angela YM %+ School of Health Sciences, Caritas Institute of Higher Education, 2 Chui Ling Lane, Tseung Kwan O, New Territories, China (Hong Kong), 852 36536664, sychan@cihe.edu.hk %K dementia %K Facebook %K social network sites %K continuous professional education %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32484441 %R 10.2196/16772 %U https://www.jmir.org/2020/6/e16772 %U https://doi.org/10.2196/16772 %U http://www.ncbi.nlm.nih.gov/pubmed/32484441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17253 %T 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 %A Guzman-Parra,Jose %A Barnestein-Fonseca,Pilar %A Guerrero-Pertiñez,Gloria %A Anderberg,Peter %A Jimenez-Fernandez,Luis %A Valero-Moreno,Esperanza %A Goodman-Casanova,Jessica Marian %A Cuesta-Vargas,Antonio %A Garolera,Maite %A Quintana,Maria %A García-Betances,Rebeca I %A Lemmens,Evi %A Sanmartin Berglund,Johan %A Mayoral-Cleries,Fermin %+ Mental Health Department, Instituto de Investigación Biomédica de Málaga, University Regional Hospital of Malaga, Plaza Hospital Civil s/n Hospital Civil 1ª Planta Pabellón 4, Malaga, Spain, 34 951 29 03 07, jgp00004@hotmail.com %K aging %K mild cognitive impairment %K dementia eHealth %K information and communication technology %K technophilia %D 2020 %7 1.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 32442136 %R 10.2196/17253 %U https://www.jmir.org/2020/6/e17253 %U https://doi.org/10.2196/17253 %U http://www.ncbi.nlm.nih.gov/pubmed/32442136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19434 %T Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guzman-Parra,Jose %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K telehealth %K confinement %K coronavirus %K COVID-19 %K well-being %K emergency response %K public health %K mental health %K physical health %K elderly %K older adults %K cognitive impairment %K dementia %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 32401215 %R 10.2196/19434 %U http://www.jmir.org/2020/5/e19434/ %U https://doi.org/10.2196/19434 %U http://www.ncbi.nlm.nih.gov/pubmed/32401215 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17255 %T Perspectives From Municipality Officials on the Adoption, Dissemination, and Implementation of Electronic Health Interventions to Support Caregivers of People With Dementia: Inductive Thematic Analysis %A Christie,Hannah Liane %A Schichel,Mignon Chloë Philomela %A Tange,Huibert Johannes %A Veenstra,Marja Yvonne %A Verhey,Frans Rochus Josef %A de Vugt,Marjolein Elizabeth %+ Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Universiteit Maastricht, Postbus 616, Maastricht, 6200 MD, Netherlands, 31 0633366811, hannah.christie@maastrichtuniversity.nl %K dementia %K caregiver %K internet %K eHealth %K implementation, senior friendly communities %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 32401217 %R 10.2196/17255 %U http://aging.jmir.org/2020/1/e17255/ %U https://doi.org/10.2196/17255 %U http://www.ncbi.nlm.nih.gov/pubmed/32401217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e14617 %T Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study %A Tsolaki,Anthoula C %A Tsolaki,Magda %A Pandria,Niki %A Lazarou,Eftychia %A Gkatzima,Olymbia %A Zilidou,Vasiliki %A Karagianni,Maria %A Iakovidou-Kritsi,Zafiroula %A Kimiskidis,Vasilios K %A Bamidis,Panagiotis D %+ Medical Physics Laboratory, School of Medicine, Aristotle University of Thessaloniki, PO Box 376, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 30 2310999310, pdbamidis@gmail.com %K mild cognitive impairment %K APOE ε4 %K computerized training %K exergaming %K Alzheimer disease %D 2020 %7 7.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Apolipoprotein E (APOE) ε4 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 ε4 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 ε4 carriers and non–APOE ε4 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 ε4 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 ε4+ 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 ΑPOE ε4+ subgroup. %M 32379048 %R 10.2196/14617 %U https://www.jmir.org/2020/5/e14617 %U https://doi.org/10.2196/14617 %U http://www.ncbi.nlm.nih.gov/pubmed/32379048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16854 %T 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 %A Rawtaer,Iris %A Mahendran,Rathi %A Kua,Ee Heok %A Tan,Hwee Pink %A Tan,Hwee Xian %A Lee,Tih-Shih %A Ng,Tze Pin %+ Department of Psychiatry, Sengkang General Hospital, Singhealth Duke NUS Academic Medical Centre, 110 Sengkang East Way, Singapore, 544886, Singapore, 65 69302288, iris.rawtaer@singhealth.com.sg %K dementia %K neurocognitive disorder %K pattern recognition, automated/methods %K internet of things %K early diagnosis %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32369031 %R 10.2196/16854 %U https://www.jmir.org/2020/5/e16854 %U https://doi.org/10.2196/16854 %U http://www.ncbi.nlm.nih.gov/pubmed/32369031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15376 %T Exploring the Hierarchical Influence of Cognitive Functions for Alzheimer Disease: The Framingham Heart Study %A Ding,Huitong %A An,Ning %A Au,Rhoda %A Devine,Sherral %A Auerbach,Sanford H %A Massaro,Joseph %A Joshi,Prajakta %A Liu,Xue %A Liu,Yulin %A Mahon,Elizabeth %A Ang,Ting FA %A Lin,Honghuang %+ Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E Concord St, E632, Boston, MA, 02118, United States, 1 6173580091, hhlin@bu.edu %K Alzheimer disease %K neuropsychological test %K stratification %K Bayesian network %K clustering %D 2020 %7 23.4.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32324139 %R 10.2196/15376 %U http://www.jmir.org/2020/4/e15376/ %U https://doi.org/10.2196/15376 %U http://www.ncbi.nlm.nih.gov/pubmed/32324139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17108 %T Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design %A Zahid,Mahnoor %A Gallant,Natasha L %A Hadjistavropoulos,Thomas %A Stroulia,Eleni %+ Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4457, hadjistt@uregina.ca %K pain measurement %K long-term care %K nursing %K technology Alzheimer disease %K mHealth %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32319955 %R 10.2196/17108 %U http://mhealth.jmir.org/2020/4/e17108/ %U https://doi.org/10.2196/17108 %U http://www.ncbi.nlm.nih.gov/pubmed/32319955 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e14389 %T Longitudinal Magnetic Resonance Imaging as a Potential Correlate in the Diagnosis of Alzheimer Disease: Exploratory Data Analysis %A Khan,Afreen %A Zubair,Swaleha %+ Aligarh Muslim University, Department of Computer Science, Adjacent Computer Centre, Anoopshahr Road, Aligarh, 202002, India, 91 9410059635, swalehaowais123@gmail.com %K Alzheimer disease %K dementia %K longitudinal %K magnetic resonance imaging %K exploratory data analysis %K Mini-Mental State Examination %K Clinical Dementia Rating %K Atlas Scaling Factor %D 2020 %7 14.4.2020 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Alzheimer disease (AD) is a degenerative progressive brain disorder where symptoms of dementia and cognitive impairment intensify over time. Numerous factors exist that may or may not be related to the lifestyle of a patient that result in a higher risk for AD. Diagnosing the disorder in its beginning period is important, and several techniques are used to diagnose AD. A number of studies have been conducted on the detection and diagnosis of AD. This paper reports the empirical study performed on the longitudinal-based magnetic resonance imaging (MRI) Open Access Series of Brain Imaging dataset. Furthermore, the study highlights several factors that influence the prediction of AD. Objective: This study aimed to correlate the effect of various factors such as age, gender, education, and socioeconomic background of patients with the development of AD. The effect of patient-related factors on the severity of AD was assessed on the basis of MRI features, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), estimated total intracranial volume (eTIV), normalized whole brain volume (nWBV), and Atlas Scaling Factor (ASF). Methods: In this study, we attempted to establish the role of longitudinal MRI in an exploratory data analysis (EDA) of AD patients. EDA was performed on the dataset of 150 patients for 343 MRI sessions (mean age 77.01 [SD 7.64] years). The T1-weighted MRI of each subject on a 1.5-Tesla Vision (Siemens) scanner was used for image acquisition. Scores of three features, MMSE, CDR, and ASF, were used to characterize the AD patients included in this study. We assessed the role of various features (ie, age, gender, education, socioeconomic status, MMSE, CDR, eTIV, nWBV, and ASF) on the prognosis of AD. Results: The analysis further establishes the role of gender in the prevalence and development of AD in older people. Moreover, a considerable relationship has been observed between education and socioeconomic position on the progression of AD. Also, outliers and linearity of each feature were determined to rule out the extreme values in measuring the skewness. The differences in nWBV between CDR=0 (nondemented), CDR=0.5 (very mild dementia), and CDR=1 (mild dementia) are significant (ie, P<.01). Conclusions: A substantial correlation has been observed between the pattern and other related features of longitudinal MRI data that can significantly assist in the diagnosis and determination of AD in older patients. %R 10.2196/14389 %U http://biomedeng.jmir.org/2020/1/e14389/ %U https://doi.org/10.2196/14389 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e18179 %T The Roles of YouTube and WhatsApp in Dementia Education for the Older Chinese American Population: Longitudinal Analysis %A Shu,Sara %A Woo,Benjamin K P %+ University of California, Los Angeles, 14445 Olive View Drive, Sylmar, CA, 91342, United States, 1 747 210 3830, sarashu@gmail.com %K dementia %K mental health %K social media %K geriatrics %K health promotion %K health education %D 2020 %7 13.4.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 32281940 %R 10.2196/18179 %U http://aging.jmir.org/2020/1/e18179/ %U https://doi.org/10.2196/18179 %U http://www.ncbi.nlm.nih.gov/pubmed/32281940 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16142 %T Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk %A Lancaster,Claire %A Koychev,Ivan %A Blane,Jasmine %A Chinner,Amy %A Wolters,Leona %A Hinds,Chris %+ Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 1865 743893, claire.lancaster@bdi.ox.ac.uk %K technology assessment %K cognition %K smartphone %K mhealth %K mobile phone %K Alzheimer disease %K early diagnosis %K feasibility study %K ecological momentary assessment %D 2020 %7 2.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32238339 %R 10.2196/16142 %U https://mhealth.jmir.org/2020/4/e16142 %U https://doi.org/10.2196/16142 %U http://www.ncbi.nlm.nih.gov/pubmed/32238339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17167 %T Efficacy of a Web App for Cognitive Training (MeMo) Regarding Cognitive and Behavioral Performance in People With Neurocognitive Disorders: Randomized Controlled Trial %A Robert,Philippe %A Manera,Valeria %A Derreumaux,Alexandre %A Ferrandez Y Montesino,Marion %A Leone,Elsa %A Fabre,Roxane %A Bourgeois,Jeremy %+ Cognition Behaviour Technology Lab, Université Côte d'Azur, Institut Claude Pompidou, 10 Rue Moliere, Nice, 06100, France, 33 0492034770, Philippe.ROBERT@univ-cotedazur.fr %K neurocognitive disorders %K Alzheimer disease %K cognition %K motivation %K apathy %K intervention %D 2020 %7 11.3.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 × 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 %M 32159519 %R 10.2196/17167 %U https://www.jmir.org/2020/3/e17167 %U https://doi.org/10.2196/17167 %U http://www.ncbi.nlm.nih.gov/pubmed/32159519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e13001 %T Online Self-Management Support for Family Caregivers Dealing With Behavior Changes in Relatives With Dementia (Part 2): Randomized Controlled Trial %A Huis in het Veld,Judith G %A Willemse,Bernadette M %A van Asch,Iris FM %A Groot Zwaaftink,Rob BM %A Verkade,Paul-Jeroen %A Twisk,Jos WR %A Verkaik,Renate %A Blom,Marco M %A van Meijel,Berno %A Francke,Anneke L %+ Department of Public and Occupational Health, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, , Netherlands, 31 20 44 45 365, Judith.huisinhetveld@inholland.nl %K dementia %K family caregivers %K self-management %K support %K intervention %D 2020 %7 25.2.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 32130142 %R 10.2196/13001 %U http://www.jmir.org/2020/2/e13001/ %U https://doi.org/10.2196/13001 %U http://www.ncbi.nlm.nih.gov/pubmed/32130142 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e14583 %T A Communication Infrastructure for the Health and Social Care Internet of Things: Proof-of-Concept Study %A Della Mea,Vincenzo %A Popescu,Mihai Horia %A Gonano,Dario %A Petaros,Tomaž %A Emili,Ivo %A Fattori,Maria Grazia %+ Department of Mathematics, Computer Science and Physics, University of Udine, Via delle Scienze 206, Udine, 33100, Italy, 39 0432 558461, vincenzo.dellamea@uniud.it %K health services for the aged %K remote sensing technology %K sensors and actuators %K embedded systems %K Internet of Things %K LoRaWAN %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32130158 %R 10.2196/14583 %U http://medinform.jmir.org/2020/2/e14583/ %U https://doi.org/10.2196/14583 %U http://www.ncbi.nlm.nih.gov/pubmed/32130158 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e14927 %T 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 %A Schüssler,Sandra %A Zuschnegg,Julia %A Paletta,Lucas %A Fellner,Maria %A Lodron,Gerald %A Steiner,Josef %A Pansy-Resch,Sandra %A Lammer,Lara %A Prodromou,Dimitrios %A Brunsch,Sebastian %A Holter,Magdalena %A Carnevale,Lorenzo %A Russegger,Silvia %+ Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, 3 Stock (DG), Graz, 8010, Austria, 43 38572076, sandra.schuessler@medunigraz.at %K dementia %K socially assistive robot %K home care %K caregiver %K dementia trainers %K motivation %K physical training %K cognitive training %K care burden %K humanoid robot %D 2020 %7 5.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %R 10.2196/14927 %U https://www.researchprotocols.org/2020/2/e14927 %U https://doi.org/10.2196/14927 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e15290 %T Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis %A Guo,Yuqi %A Yang,Fan %A Hu,Fei %A Li,Wei %A Ruggiano,Nicole %A Lee,Hee Yun %+ Social Welfare Program, School of Public Administration, Dongbei University of Finance and Economics, 219 Quanxue Hall, 217 Jianshan Street, Shaohekou District, Dalian, 116025, China, 86 41184710562, fyang10@dufe.edu.cn %K alzheimer disease %K dementia %K self-care %K mobile phone apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Aging %G English %X 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. %M 32012045 %R 10.2196/15290 %U http://aging.jmir.org/2020/1/e15290/ %U https://doi.org/10.2196/15290 %U http://www.ncbi.nlm.nih.gov/pubmed/32012045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16808 %T A Web-Based Dementia Education Program and its Application to an Australian Web-Based Dementia Care Competency and Training Network: Integrative Systematic Review %A Moehead,Anne %A DeSouza,Kathryn %A Walsh,Karen %A Pit,Sabrina W %+ Northern New South Wales Local Health District, New South Wales Ministry of Health, Uralba St, Lismore, 2480, Australia, 61 429449591, gmo11800@dodo.com.au %K education %K workforce %K online learning %K Web-based learning %K distance education %K dementia %K nursing %K facilitated learning %K competency %K training %K network %K capability %K skills %K person-centered %D 2020 %7 22.1.2020 %9 Review %J J Med Internet Res %G English %X 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. %M 32012077 %R 10.2196/16808 %U http://www.jmir.org/2020/1/e16808/ %U https://doi.org/10.2196/16808 %U http://www.ncbi.nlm.nih.gov/pubmed/32012077 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e16790 %T Atypical Repetition in Daily Conversation on Different Days for Detecting Alzheimer Disease: Evaluation of Phone-Call Data From a Regular Monitoring Service %A Yamada,Yasunori %A Shinkawa,Kaoru %A Shimmei,Keita %+ IBM Research, 19-21, Nihonbashi, Hakozaki-cho, Chuo-ku, Tokyo, , Japan, 81 80 6706 9381, ysnr@jp.ibm.com %K dementia %K Alzheimer disease %K speech analysis %K screening %K monitoring %K behavioral marker %K daily conversation %D 2020 %7 14.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X 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. %R 10.2196/16790 %U http://mental.jmir.org/2020/1/e16790/ %U https://doi.org/10.2196/16790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e12504 %T 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 %A Efthymiou,Areti %A Middleton,Nicos %A Charalambous,Andreas %A Papastavrou,Evridiki %+ Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, ZT3, 3rd Floor, 15 Vragadinou Street, Limassol, 3041, Cyprus, 357 25002285, arefthymiou@yahoo.com %K eHealth %K literacy %K scales %K carers %K technology %K chronic disease %D 2019 %7 28.11.2019 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 31778120 %R 10.2196/12504 %U http://www.jmir.org/2019/11/e12504/ %U https://doi.org/10.2196/12504 %U http://www.ncbi.nlm.nih.gov/pubmed/31778120 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15122 %T Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review %A Koo,Bon Mi %A Vizer,Lisa M %+ SSK Research Center for Mental Health and Communal Society, Kwangwoon University, Chambit 604, 20 Gwangun-ro, Nowon-gu, Seoul, 01897, Republic of Korea, 82 2 940 5430, bmkmon@gmail.com %K dementia %K Alzheimer disease %K mobile health %K consumer health informatics %K personhood %K systematic review %K smartphone %K mobile phone %K tablet computers %D 2019 %7 11.11.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 31710305 %R 10.2196/15122 %U https://mhealth.jmir.org/2019/11/e15122 %U https://doi.org/10.2196/15122 %U http://www.ncbi.nlm.nih.gov/pubmed/31710305 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15733 %T Engagement With a Digital Platform for Multimodal Cognitive Assessment and Multidomain Intervention in a Japanese Population: Pilot, Quasi-Experimental, Longitudinal Study %A Glenn,Jordan %A Madero,Erica Nicole %A Gray,Michelle %A Fuseya,Nami %A Ikeda,Mari %A Kawamura,Tomoo %A Arita,Yoshiko %A Bott,Nick Thomas %+ Neurotrack Technologies Inc, 399 Bradford St, Suite 101, Redwood City, CA, 94063, United States, 1 15615133865, jordan@neurotrack.com %K cognitive decline %K Alzheimer disease %K lifestyle risk reduction %K digital health %K FINGER %K neurocognitive tests %K cognition %K dementia %D 2019 %7 25.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31654567 %R 10.2196/15733 %U http://mhealth.jmir.org/2019/10/e15733/ %U https://doi.org/10.2196/15733 %U http://www.ncbi.nlm.nih.gov/pubmed/31654567 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12346 %T Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series %A Thorpe,Julia %A Forchhammer,Birgitte Hysse %A Maier,Anja M %+ Engineering Systems Design, DTU Management, Technical University of Denmark, Diplomvej, Building 317, Kongens Lyngby, 2800, Denmark, 45 45256045, amai@dtu.dk %K dementia %K cognitive rehabilitation %K mobility %K activity %K mHealth %K uHealth %K pervasive health care %K P4 health care %K health care design %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 31625951 %R 10.2196/12346 %U http://formative.jmir.org/2019/4/e12346/ %U https://doi.org/10.2196/12346 %U http://www.ncbi.nlm.nih.gov/pubmed/31625951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e14106 %T An Online Minimally Guided Intervention to Support Family and Other Unpaid Carers of People With Dementia: Protocol for a Randomized Controlled Trial %A Pinto-Bruno,Ángel C %A Pot,Anne Margriet %A Kleiboer,Annet %A Droes,Rose-Marie %A van Straten,Annemieke %+ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Room: MF-A525, Amsterdam, Netherlands, 31 20 598 67 27, a.c.pintobruno@vu.nl %K informal carers %K dementia %K ICT intervention %K online %K perceived stress %D 2019 %7 10.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31603433 %R 10.2196/14106 %U http://www.researchprotocols.org/2019/10/e14106/ %U https://doi.org/10.2196/14106 %U http://www.ncbi.nlm.nih.gov/pubmed/31603433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 9 %P e14096 %T 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 %A Goodall,Gemma %A Ciobanu,Ileana %A Taraldsen,Kristin %A Sørgaard,Jon %A Marin,Andreea %A Draghici,Rozeta %A Zamfir,Mihai-Viorel %A Berteanu,Mihai %A Maetzler,Walter %A Serrano,J Artur %+ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, , Trondheim,, Norway, 47 40554367, gemma.goodall@ntnu.no %K dementia %K emotions %K technology %K multimedia %K eHealth %D 2019 %7 19.8.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31538942 %R 10.2196/14096 %U https://www.researchprotocols.org/2019/9/e14096 %U https://doi.org/10.2196/14096 %U http://www.ncbi.nlm.nih.gov/pubmed/31538942 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 9 %P e13887 %T An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study %A Ijaz,Kiran %A Ahmadpour,Naseem %A Naismith,Sharon L %A Calvo,Rafael A %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, North Ryde,, Sydney, 2109, Australia, 61 298502494, kiran.ijaz@mq.edu.au %K virtual reality %K healthy aging %K memory %K cognition %K dementia %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 31482851 %R 10.2196/13887 %U https://mental.jmir.org/2019/9/e13887/ %U https://doi.org/10.2196/13887 %U http://www.ncbi.nlm.nih.gov/pubmed/31482851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14530 %T Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study %A Gilson,Aaron %A Dodds,Debby %A Kaur,Arveen %A Potteiger,Michael %A Ford II,James H %+ University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K mood change %K caregiver interactions %K older adults %K Alzheimer disease %K dementia %K computer tablets %K person-centered care %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Form Res %G English %X 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 (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=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 (χ24=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. %M 31482847 %R 10.2196/14530 %U http://formative.jmir.org/2019/3/e14530/ %U https://doi.org/10.2196/14530 %U http://www.ncbi.nlm.nih.gov/pubmed/31482847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12785 %T 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 %A Piau,Antoine %A Wild,Katherine %A Mattek,Nora %A Kaye,Jeffrey %+ Oregon Center for Aging and Technology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, United States, 1 971 230 8664, antoinepiau@hotmail.com %K technology %K Alzheimer disease %K cognition disorders %K dementia %K older adults %K digital biomarkers %K digital phenotyping %K digital health %D 2019 %7 30.08.2019 %9 Review %J J Med Internet Res %G English %X 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. %M 31471958 %R 10.2196/12785 %U http://www.jmir.org/2019/8/e12785/ %U https://doi.org/10.2196/12785 %U http://www.ncbi.nlm.nih.gov/pubmed/31471958 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e13139 %T Cox Proportional Hazard Regression Versus a Deep Learning Algorithm in the Prediction of Dementia: An Analysis Based on Periodic Health Examination %A Kim,Woo Jung %A Sung,Ji Min %A Sung,David %A Chae,Myeong-Hun %A An,Suk Kyoon %A Namkoong,Kee %A Lee,Eun %A Chang,Hyuk-Jae %+ Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1620, leeeun@yuhs.ac %K dementia %K deep learning %K proportional hazards models %D 2019 %7 30.08.2019 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 31471957 %R 10.2196/13139 %U http://medinform.jmir.org/2019/3/e13139/ %U https://doi.org/10.2196/13139 %U http://www.ncbi.nlm.nih.gov/pubmed/31471957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P 13280 %T Development of a Caregivers’ Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study %A Guisado-Fernandez,Estefania %A Caulfield,Brian %A Silva,Paula Alexandra %A Mackey,Laura %A Singleton,David %A Leahy,Daniel %A Dossot,Sébastien %A Power,Dermot %A O'Shea,Diarmuid %A Blake,Catherine %+ Insight Centre for Data Analytics, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield University Campus, Dublin, D4, Ireland, 353 0838345003, estefaniaguisadofernandez@gmail.com %K connected health %K dementia %K caregivers %K home care %K home monitoring %D 2019 %7 28.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31464187 %R 10.2196/13280 %U http://www.researchprotocols.org/2019/8/e13280/ %U https://doi.org/10.2196/13280 %U http://www.ncbi.nlm.nih.gov/pubmed/31464187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e11340 %T Users’ Experiences With Web-Based Health Care Information: Qualitative Study About Diabetes and Dementia Information Presented on a Governmental Website %A Wiegers,Therese Agnes %A Hendriks,Michelle %A Malanda,Uriëll %A de Boer,Dolf %+ Nivel, Otterstraat 118-124, 3513CR, Utrecht,, Netherlands, 33 30 2729 658, D.deBoer@nivel.nl %K patients %K qualitative research %K choice behavior %D 2019 %7 08.07.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 31287066 %R 10.2196/11340 %U https://www.jmir.org/2019/7/e11340/ %U https://doi.org/10.2196/11340 %U http://www.ncbi.nlm.nih.gov/pubmed/31287066 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13417 %T Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease %A van Maurik,Ingrid S %A Visser,Leonie NC %A Pel-Littel,Ruth E %A van Buchem,Marieke M %A Zwan,Marissa D %A Kunneman,Marleen %A Pelkmans,Wiesje %A Bouwman,Femke H %A Minkman,Mirella %A Schoonenboom,Niki %A Scheltens,Philip %A Smets,Ellen MA %A van der Flier,Wiesje M %+ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440816, i.vanmaurik@vumc.nl %K Alzheimer’s disease %K biomarkers %K decision aids %K mild cognitive impairment %K precision medicine %K risk %K shared decision making %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 31287061 %R 10.2196/13417 %U https://formative.jmir.org/2019/3/e13417/ %U https://doi.org/10.2196/13417 %U http://www.ncbi.nlm.nih.gov/pubmed/31287061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13360 %T The Symptoms Targeted for Monitoring in a Web-Based Tracking Tool by Caregivers of People With Dementia and Agitation: Cross-Sectional Study %A Rockwood,Kenneth %A Sanon Aigbogun,Myrlene %A Stanley,Justin %A Wong,Helen %A Dunn,Taylor %A Chapman,Chère A T %A Howlett,Susan E %A Miguelez,Maia %A McGarrigle,Lisa %A Baker,Ross A %+ Geriatric Medicine Research Unit, Nova Scotia Health Authority, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E9, Canada, 1 902 473 8687, kenneth.rockwood@dal.ca %K Alzheimer disease %K dementia %K agitation %K neuropsychiatric symptoms %K internet %K caregiver %D 2019 %7 28.06.2019 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ23=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. %M 31254339 %R 10.2196/13360 %U https://www.jmir.org/2019/6/e13360/ %U https://doi.org/10.2196/13360 %U http://www.ncbi.nlm.nih.gov/pubmed/31254339 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13711 %T 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 %A Anderberg,Peter %A Barnestein-Fonseca,Pilar %A Guzman-Parra,Jose %A Garolera,Maite %A Quintana,María %A Mayoral-Cleries,Fermin %A Lemmens,Evi %A Sanmartin Berglund,Johan %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37179, Sweden, 46 734223736, pan@bth.se %K dementia %K mild cognitive impairment %K tablet %K app %K carer %K eHealth %K mHealth %D 2019 %7 21.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31228177 %R 10.2196/13711 %U http://www.researchprotocols.org/2019/6/e13711/ %U https://doi.org/10.2196/13711 %U http://www.ncbi.nlm.nih.gov/pubmed/31228177 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13378 %T A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial %A McCarron,Hayley R %A Zmora,Rachel %A Gaugler,Joseph E %+ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, D351 Mayo, 425 Delaware Street SE, Minneapolis, MN,, United States, 1 612 626 9552, mccar988@umn.edu %K Alzheimer disease %K dementia %K social support %K quality of life %K well-being %K technology %K social engagement %K facial recognition %K smartwatch %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Aging %G English %X 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) %M 31518270 %R 10.2196/13378 %U http://aging.jmir.org/2019/1/e13378/ %U https://doi.org/10.2196/13378 %U http://www.ncbi.nlm.nih.gov/pubmed/31518270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12013 %T Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care %A Thorpe,Julia Rosemary %A Forchhammer,Birgitte Hysse %A Maier,Anja M %+ Engineering Systems Group, DTU Management, Technical University of Denmark, Diplomvej, Building 371, Kongens Lyngby, 2800, Denmark, 45 30113332, jrth@dtu.dk %K ambulatory monitoring %K patient-centered care %K physical activity %K dementia %K wearable electronics devices %K activity trackers %K mHealth %K human behavior %K system design %D 2019 %7 30.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31199304 %R 10.2196/12013 %U https://mhealth.jmir.org/2019/6/e12013/ %U https://doi.org/10.2196/12013 %U http://www.ncbi.nlm.nih.gov/pubmed/31199304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e14110 %T Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter %A Alvarez-Mon,Miguel Angel %A Llavero-Valero,María %A Sánchez-Bayona,Rodrigo %A Pereira-Sanchez,Victor %A Vallejo-Valdivielso,Maria %A Monserrat,Jorge %A Lahera,Guillermo %A Asunsolo del Barco,Angel %A Alvarez-Mon,Melchor %+ Department of Psychiatry, Clinica Universidad de Navarra, Avda Pio XII, 36, Pamplona, 31008, Spain, 34 948255400, maalvarezdemon@icloud.com %K social stigma %K social media %K psychosis %K breast cancer %K HIV %K dementia %K public opinion %K diabetes %D 2019 %7 28.05.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 31140438 %R 10.2196/14110 %U http://www.jmir.org/2019/5/e14110/ %U https://doi.org/10.2196/14110 %U http://www.ncbi.nlm.nih.gov/pubmed/31140438 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13302 %T Weekly, Seasonal, and Geographic Patterns in Health Contemplations About Sundown Syndrome: An Ecological Correlational Study %A Madden,Kenneth Michael %A Feldman,Boris %+ Gerontology and Diabetes Research Laboratory, University of British Columbia, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4931, kmmadden@mail.ubc.ca %K sundown syndrome %K geriatric medicine %K dementia %K circadian rhythms %K infodemiology %K infoveillance %K internet %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Aging %G English %X 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, β=-.429 [SD .149], P=.006) and showed a positive association with increasing latitude (R2=.38, β=.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. %M 31518264 %R 10.2196/13302 %U http://aging.jmir.org/2019/1/e13302/ %U https://doi.org/10.2196/13302 %U http://www.ncbi.nlm.nih.gov/pubmed/31518264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13333 %T Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study %A Martens,Kris %A Takano,Keisuke %A Barry,Tom J %A Goedleven,Jolien %A Van den Meutter,Louise %A Raes,Filip %+ Department of Psychology, The University of Hong Kong, Jockey Club Tower, Pokfulam Road, Hong Kong,, China, 86 3917 8927, tom.j.barry@icloud.com %K memory specificity training %K autobiographical memory %K cognitive aging %K online %K depression %K memory %K telemedicine %K rumination, cognitive %D 2019 %7 14.05.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 31094362 %R 10.2196/13333 %U https://www.jmir.org/2019/5/e13333/ %U https://doi.org/10.2196/13333 %U http://www.ncbi.nlm.nih.gov/pubmed/31094362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13415 %T Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis %A Zhao,Yinan %A Feng,Hui %A Hu,Mingyue %A Hu,Hengyu %A Li,Hui %A Ning,Hongting %A Chen,Huijing %A Liao,Lulu %A Peng,Linlin %+ Xiangya School of Nursing, Central South University, No 172 Tongzipo Road, Changsha,, China, 86 82650292, feng.hui@csu.edu.cn %K internet %K education %K mental health %K caregivers %K dementia %D 2019 %7 6.5.2019 %9 Review %J J Med Internet Res %G English %X 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. %M 31066680 %R 10.2196/13415 %U http://www.jmir.org/2019/5/e13415/ %U https://doi.org/10.2196/13415 %U http://www.ncbi.nlm.nih.gov/pubmed/31066680 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12192 %T Factors Influencing the Adoption of Smart Health Technologies for People With Dementia and Their Informal Caregivers: Scoping Review and Design Framework %A Guisado-Fernández,Estefanía %A Giunti,Guido %A Mackey,Laura M %A Blake,Catherine %A Caulfield,Brian Michael %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Science Building East, 3rd Floor, Belfield Campus, Dublin, D4, Ireland, 353 0838345003, estefaniaguisadofernandez@gmail.com %K dementia %K informal caregiver %K smart health technologies %K user-centered design %K technology adoption %D 2019 %7 30.04.2019 %9 Review %J JMIR Aging %G English %X 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. %M 31518262 %R 10.2196/12192 %U http://aging.jmir.org/2019/1/e12192/ %U https://doi.org/10.2196/12192 %U http://www.ncbi.nlm.nih.gov/pubmed/31518262 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12870 %T Functional Magnetic Resonance Imaging Biomarkers Predicting Cognitive Progression in Parkinson Disease: Protocol for a Prospective Longitudinal Cohort Study %A Hanna-Pladdy,Brenda %A Gullapalli,Rao %A Chen,Hegang %+ Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 670 West Baltimore Street, Baltimore, MD, 21201, United States, 1 410 706 5967, Brenda.Hanna-pladdy@umm.edu %K Parkinson disease %K cognition %K disease progression %K dementia %K mild cognitive impairment %K biomarkers %K functional neuroimaging %D 2019 %7 29.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 α-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 (α-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 %M 31033450 %R 10.2196/12870 %U http://www.researchprotocols.org/2019/4/e12870/ %U https://doi.org/10.2196/12870 %U http://www.ncbi.nlm.nih.gov/pubmed/31033450 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12104 %T Web-Based Multidomain Lifestyle Programs for Brain Health: Comprehensive Overview and Meta-Analysis %A Wesselman,Linda MP %A Hooghiemstra,Astrid M %A Schoonmade,Linda J %A de Wit,Marjolein CJ %A van der Flier,Wiesje M %A Sikkes,Sietske AM %+ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam,, Netherlands, 31 204448527, l.wesselman@vumc.nl %K meta-analysis %K telemedicine %K internet %K lifestyle %K healthy aging %K cognition %K dementia %K health promotion %K primary prevention %D 2019 %7 09.04.2019 %9 Review %J JMIR Ment Health %G English %X 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. %M 30964438 %R 10.2196/12104 %U http://mental.jmir.org/2019/4/e12104/ %U https://doi.org/10.2196/12104 %U http://www.ncbi.nlm.nih.gov/pubmed/30964438 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12850 %T Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing %A Sikder,Abu Taher %A Yang,Francis Cheng %A Schafer,Rhiana %A Dowling,Glenna A %A Traeger,Lara %A Jain,Felipe Ananda %+ Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 4682, felipe.jain@post.harvard.edu %K family caregivers %K mindfulness %K depression %K mobile apps %K psychotherapy %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518275 %R 10.2196/12850 %U http://aging.jmir.org/2019/1/e12850/ %U https://doi.org/10.2196/12850 %U http://www.ncbi.nlm.nih.gov/pubmed/31518275 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12615 %T A Rapid, Mobile Neurocognitive Screening Test to Aid in Identifying Cognitive Impairment and Dementia (BrainCheck): Cohort Study %A Groppell,Samantha %A Soto-Ruiz,Karina M %A Flores,Benjamin %A Dawkins,William %A Smith,Isabella %A Eagleman,David M %A Katz,Yael %+ BrainCheck Inc, 2450 Holcombe Blvd Ste X+240, Houston, TX, 77021, United States, 1 8326816760, karina.soto.md@gmail.com %K dementia %K neurocognitive tests %K neurocognitive computerized assessment tools (NCAT) %K mild cognitive impairment (MCI) %K BrainCheck %K digital testing %K Alzheimer’s disease %K electronic neurocognitive tools %K computerized cognitive assessment %K digital cognitive assessment %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X 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) %M 31518280 %R 10.2196/12615 %U http://aging.jmir.org/2019/1/e12615/ %U https://doi.org/10.2196/12615 %U http://www.ncbi.nlm.nih.gov/pubmed/31518280 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e11599 %T Evaluating the Impact of Music & Memory’s Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study %A Ford II,James H %A Dodds,Debby %A Hyland,Julie %A Potteiger,Michael %+ School of Pharmacy, University of Wisconsin–Madison, 777 Highland Avenue, Madison, WI, 53705, United States, 1 6082624748, jhfordii@wisc.edu %K Music & Memory %K assisted living facilities %K quality of life %K agitation %K medication adherance %K iPod %K iPad %K implementation science %K patient participation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518259 %R 10.2196/11599 %U http://aging.jmir.org/2019/1/e11599/ %U https://doi.org/10.2196/11599 %U http://www.ncbi.nlm.nih.gov/pubmed/31518259 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13135 %T Design and Development of the Brain Training System for the Digital “Maintain Your Brain” Dementia Prevention Trial %A Walton,Courtney Campbell %A Lampit,Amit %A Boulamatsis,Christos %A Hallock,Harry %A Barr,Polly %A Ginige,Jeewani Anupama %A Brodaty,Henry %A Chau,Tiffany %A Heffernan,Megan %A Sachdev,Perminder Singh %A Fiatarone Singh,Maria A %A Valenzuela,Michael %+ Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 2 9114 4135, michael.valenzuela@sydney.edu.au %K computerized cognitive training %K dementia %K clinical trial design %K older adults %D 2019 %7 27.02.2019 %9 Viewpoint %J JMIR Aging %G English %X 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 %M 31518277 %R 10.2196/13135 %U http://aging.jmir.org/2019/1/e13135/ %U https://doi.org/10.2196/13135 %U http://www.ncbi.nlm.nih.gov/pubmed/31518277 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e10952 %T User-Driven Living Lab for Assistive Technology to Support People With Dementia Living at Home: Protocol for Developing Co-Creation–Based Innovations %A van den Kieboom,Robin CP %A Bongers,Inge MB %A Mark,Ruth E %A Snaphaan,Liselore JAE %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Reitse Poort, 2nd Floor, Professor Cobbenhagenlaan 125, Tilburg, 5037 DB, Netherlands, 31 0683669336, r.c.p.vdnkieboom@tilburguniversity.edu %K dementia %K family caregivers %K longitudinal studies %K technology %D 2019 %7 28.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 30688653 %R 10.2196/10952 %U http://www.researchprotocols.org/2019/1/e10952/ %U https://doi.org/10.2196/10952 %U http://www.ncbi.nlm.nih.gov/pubmed/30688653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11682 %T Mobile Health, Information Preferences, and Surrogate Decision-Making Preferences of Family Caregivers of People With Dementia in Rural Hispanic Communities: Cross-Sectional Questionnaire Study %A Xie,Bo %A Champion,Jane Dimmitt %A Kwak,Jung %A Fleischmann,Kenneth R %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 512 232 5788, boxie@utexas.edu %K mHealth %K dementia %K caregivers %K rural communities %D 2018 %7 10.12.2018 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ21=17.2, P<.001) and in the caregiver group (χ21=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. %M 30530450 %R 10.2196/11682 %U https://www.jmir.org/2018/12/e11682/ %U https://doi.org/10.2196/11682 %U http://www.ncbi.nlm.nih.gov/pubmed/30530450 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11542 %T Analyzing Twitter as a Platform for Alzheimer-Related Dementia Awareness: Thematic Analyses of Tweets %A Cheng,Tiffany Yi-mei %A Liu,Lisa %A Woo,Benjamin KP %+ University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, United States, 1 626 321 5215, lisa96liu@gmail.com %K social media %K Twitter %K dementia %K social support %D 2018 %7 10.12.2018 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518232 %R 10.2196/11542 %U http://aging.jmir.org/2018/2/e11542/ %U https://doi.org/10.2196/11542 %U http://www.ncbi.nlm.nih.gov/pubmed/31518232 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e12274 %T Commercially Available Mobile Apps for Caregivers of People With Alzheimer Disease or Other Related Dementias: Systematic Search %A Wozney,Lori %A Freitas de Souza,Luciane M %A Kervin,Emily %A Queluz,Francine %A McGrath,Patrick J %A Keefe,Janice %+ Nova Scotia Health Authority, 302 Pleasant Street, Dartmouth, NS, B2Y 3Z9, Canada, 1 9024490603, loriwozney@gmail.com %K alzheimer and other related dementias %K apps %K caregivers %K eHealth %K mobile phone %D 2018 %7 07.12.2018 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518255 %R 10.2196/12274 %U http://aging.jmir.org/2018/2/e12274/ %U https://doi.org/10.2196/12274 %U http://www.ncbi.nlm.nih.gov/pubmed/31518255 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e4 %T Digital Access in Working-Age and Older Adults and Their Caregivers Attending Psychiatry Outpatient Clinics: Quantitative Survey %A Cruickshank,Callum %A MacIntyre,Donald J %+ Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Old College, South Bridge, Edinburgh,, United Kingdom, 44 1316501000, callum.cruickshank@ed.ac.uk %K general psychiatry %K internet access %K memory assessment and treatment service %K mobile phone %K old age psychiatry %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518247 %R 10.2196/aging.9130 %U http://aging.jmir.org/2018/2/e4/ %U https://doi.org/10.2196/aging.9130 %U http://www.ncbi.nlm.nih.gov/pubmed/31518247 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e57 %T Using Mobile Technology to Provide Personalized Reminiscence for People Living With Dementia and Their Carers: Appraisal of Outcomes From a Quasi-Experimental Study %A Laird,Elizabeth A %A Ryan,Assumpta %A McCauley,Claire %A Bond,Raymond B %A Mulvenna,Maurice D %A Curran,Kevin J %A Bunting,Brendan %A Ferry,Finola %A Gibson,Aideen %+ Institute of Nursing and Health Research, Ulster University, Northland Road, Derry, BT48 7JL, United Kingdom, 44 2871675006 ext 75006, ea.laird@ulster.ac.uk %K dementia %K evaluation %K mobile apps %K reminiscence %K research %K technology %K mobile phone %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 30206053 %R 10.2196/mental.9684 %U http://mental.jmir.org/2018/3/e57/ %U https://doi.org/10.2196/mental.9684 %U http://www.ncbi.nlm.nih.gov/pubmed/30206053 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e11368 %T 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 %A Bott,Nicholas %A Kumar,Shefali %A Krebs,Caitlyn %A Glenn,Jordan M %A Madero,Erica N %A Juusola,Jessie L %+ Neurotrack Technologies, Inc, 399 Bradford Street #101, Redwood City, CA, 94063, United States, 1 6172933703, erica@neurotrack.com %K cognitive impairment %K dementia %K Alzheimer disease %K lifestyle intervention %K digital health %K health coaching %K cognitive dysfunction %K risk reduction behavior %D 2018 %7 13.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X 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 %M 30104186 %R 10.2196/11368 %U http://www.researchprotocols.org/2018/8/e11368/ %U https://doi.org/10.2196/11368 %U http://www.ncbi.nlm.nih.gov/pubmed/30104186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e171 %T Designing and Implementing a Home-Based Couple Management Guide for Couples Where One Partner has Dementia (DemPower): Protocol for a Nonrandomized Feasibility Trial %A Lasrado,Reena %A Bielsten,Therése %A Hann,Mark %A Davies,Linda %A Schumm,James %A Reilly,Siobhan %A Swarbrick,Caroline %A Keady,John %A Hellström,Ingrid %+ Division of Nursing, Midwifery & Social Work, The University of Manchester, Jean McFarlane Building, University Place, Manchester, M13 9PL, United Kingdom, 44 161 306 7884, reena.lasrado@manchester.ac.uk %K dementia %K couple management guide %K dementia self-help %K dementia intervention %D 2018 %7 10.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 30097423 %R 10.2196/resprot.9087 %U http://www.researchprotocols.org/2018/8/e171/ %U https://doi.org/10.2196/resprot.9087 %U http://www.ncbi.nlm.nih.gov/pubmed/30097423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e11143 %T Device-Embedded Cameras for Eye Tracking–Based Cognitive Assessment: Validation With Paper-Pencil and Computerized Cognitive Composites %A Bott,Nicholas %A Madero,Erica N %A Glenn,Jordan %A Lange,Alexander %A Anderson,John %A Newton,Doug %A Brennan,Adam %A Buffalo,Elizabeth A %A Rentz,Dorene %A Zola,Stuart %+ Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, 75 Alta Road, Stanford, CA, 94306, United States, 1 650 814 9383, nbott@stanford.edu %K eye tracking %K visual paired comparison %K preclinical Alzheimer’s disease %K neuropsychological testing %D 2018 %7 24.07.2018 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 30042093 %R 10.2196/11143 %U http://www.jmir.org/2018/7/e11143/ %U https://doi.org/10.2196/11143 %U http://www.ncbi.nlm.nih.gov/pubmed/30042093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10017 %T Effectiveness of a Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Randomized Controlled Trial %A Boots,Lizzy MM %A de Vugt,Marjolein E %A Kempen,Gertrudis IJM %A Verhey,Frans RJ %+ Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, Maastricht University Medical Center, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 43 3881994, l.boots@maastrichtuniversity.nl %K internet %K caregivers %K technology %K therapeutics %D 2018 %7 13.07.2018 %9 Original Paper %J J Med Internet Res %G English %X 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) %M 30006327 %R 10.2196/10017 %U http://www.jmir.org/2018/7/e10017/ %U https://doi.org/10.2196/10017 %U http://www.ncbi.nlm.nih.gov/pubmed/30006327 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10493 %T Unsupervised Machine Learning to Identify High Likelihood of Dementia in Population-Based Surveys: Development and Validation Study %A Cleret de Langavant,Laurent %A Bayen,Eleonore %A Yaffe,Kristine %+ Service de Neurologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 3ème étage, Créteil, 94000, France, 33 149812308, laurent.cleret@gbhi.org %K dementia %K cognition disorders %K health surveys %K electronic health records %K diagnosis %K unsupervised machine learning %K cluster analysis %K data mining %D 2018 %7 09.07.2018 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 29986849 %R 10.2196/10493 %U http://www.jmir.org/2018/7/e10493/ %U https://doi.org/10.2196/10493 %U http://www.ncbi.nlm.nih.gov/pubmed/29986849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10484 %T Web-Based Intervention for Family Carers of Persons with Dementia and Multiple Chronic Conditions (My Tools 4 Care): Pragmatic Randomized Controlled Trial %A Duggleby,Wendy %A Ploeg,Jenny %A McAiney,Carrie %A Peacock,Shelley %A Fisher,Kathryn %A Ghosh,Sunita %A Markle-Reid,Maureen %A Swindle,Jennifer %A Williams,Allison %A Triscott,Jean AC %A Forbes,Dorothy %A Jovel Ruiz,Kathya %+ Faculty of Nursing, University of Alberta, Level 3, ECHA, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6764, wendy.duggleby@ualberta.ca %K carers %K dementia %K treatment %K internet %D 2018 %7 29.06.2018 %9 Original Paper %J J Med Internet Res %G English %X 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). %M 29959111 %R 10.2196/10484 %U http://www.jmir.org/2018/6/e10484/ %U https://doi.org/10.2196/10484 %U http://www.ncbi.nlm.nih.gov/pubmed/29959111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e216 %T Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review %A Hopwood,Jenny %A Walker,Nina %A McDonagh,Lorraine %A Rait,Greta %A Walters,Kate %A Iliffe,Stephen %A Ross,Jamie %A Davies,Nathan %+ Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, Royal Free Hospital, London, NW3 2PF, United Kingdom, 44 2077940500 ext 34141, n.m.davies@ucl.ac.uk %K dementia %K caregivers %K internet %K review %D 2018 %7 12.06.2018 %9 Review %J J Med Internet Res %G English %X 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. %M 29895512 %R 10.2196/jmir.9548 %U http://www.jmir.org/2018/6/e216/ %U https://doi.org/10.2196/jmir.9548 %U http://www.ncbi.nlm.nih.gov/pubmed/29895512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e194 %T Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial %A Rapoport,Mark J %A Zucchero Sarracini,Carla %A Kiss,Alex %A Lee,Linda %A Byszewski,Anna %A Seitz,Dallas P %A Vrkljan,Brenda %A Molnar,Frank %A Herrmann,Nathan %A Tang-Wai,David F %A Frank,Christopher %A Henry,Blair %A Pimlott,Nicholas %A Masellis,Mario %A Naglie,Gary %+ Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 4085, mark.rapoport@sunnybrook.ca %K dementia %K mild cognitive impairment %K automobile driving %K decision support systems, clinical %D 2018 %7 25.05.2018 %9 Original Paper %J J Med Internet Res %G English %X 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) %M 29802093 %R 10.2196/jmir.9126 %U http://www.jmir.org/2018/5/e194/ %U https://doi.org/10.2196/jmir.9126 %U http://www.ncbi.nlm.nih.gov/pubmed/29802093 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e31 %T Cognitive Assessment of Patients With Alzheimer's Disease by Telemedicine: Pilot Study %A Carotenuto,Anna %A Rea,Raffaele %A Traini,Enea %A Ricci,Giovanna %A Fasanaro,Angiola Maria %A Amenta,Francesco %+ Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Via Madonna delle Carceri no 9, Camerino, 62032, Italy, 39 0737401725, enea.traini@unicam.it %K dementia %K telemedicine %K videoconference %K telepsychology %K MMSE by videoconference %K ADAS-cog by videoconference %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 29752254 %R 10.2196/mental.8097 %U http://mental.jmir.org/2018/2/e31/ %U https://doi.org/10.2196/mental.8097 %U http://www.ncbi.nlm.nih.gov/pubmed/29752254 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e21 %T An Assistive Technology System that Provides Personalized Dressing Support for People Living with Dementia: Capability Study %A Burleson,Winslow %A Lozano,Cecil %A Ravishankar,Vijay %A Lee,Jisoo %A Mahoney,Diane %+ NYU-X, College of Nursing, New York University, 433 1st Ave, New York, NY, 10010, United States, 1 4802523929, wb50@nyu.edu %K Alzheimer disease %K disorders, neurocognitive %K image processing, computer-assisted %D 2018 %7 01.05.2018 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 29716885 %R 10.2196/medinform.5587 %U http://medinform.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/medinform.5587 %U http://www.ncbi.nlm.nih.gov/pubmed/29716885 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 1 %P e2 %T A Web-Based Intervention to Help Caregivers of Older Adults With Dementia and Multiple Chronic Conditions: Qualitative Study %A Ploeg,Jenny %A McAiney,Carrie %A Duggleby,Wendy %A Chambers,Tracey %A Lam,Annie %A Peacock,Shelley %A Fisher,Kathryn %A Forbes,Dorothy Anne %A Ghosh,Sunita %A Markle-Reid,Maureen %A Triscott,Jean %A Williams,Allison %+ School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre, Room HSC 3N25C, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22294, ploegj@mcmaster.ca %K Internet %K Web-based interventions %K qualitative research %K caregivers %K aged %K dementia %K multiple chronic conditions %D 2018 %7 23.04.2018 %9 Original Paper %J JMIR Aging %G English %X 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. %M 31518230 %R 10.2196/aging.8475 %U http://aging.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/aging.8475 %U http://www.ncbi.nlm.nih.gov/pubmed/31518230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e4 %T A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability %A Zafeiridi,Paraskevi %A Paulson,Kevin %A Dunn,Rosie %A Wolverson,Emma %A White,Caroline %A Thorpe,Jonathan Adrian %A Antomarini,Marco %A Cesaroni,Francesca %A Scocchera,Francesca %A Landrin-Dutot,Isabelle %A Malherbe,Laëtitia %A Lingiah,Hendi %A Bérard,Marie %A Gironès,Xavier %A Quintana,Maria %A Cortés,Ulises %A Barrué,Cristian %A Cortés,Atia %A Paliokas,Ioannis %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ School of Engineering and Computer Science, University of Hull, Aire Building, Cottingham Road, Hull, HU67RX, United Kingdom, 44 01482464571 ext 4571, P.Zafeiridi@hull.ac.uk %K dementia %K technology %K social support %K caregivers %D 2018 %7 12.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X 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. %M 30684403 %R 10.2196/formative.9083 %U http://formative.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/formative.9083 %U http://www.ncbi.nlm.nih.gov/pubmed/30684403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e56 %T Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol %A Wallack,Elizabeth M %A Harris,Chelsea %A Ploughman,Michelle %A Butler,Roger %+ Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd, Room 400, 4th Floor, L.A. Miller Centre, St John's, NL, A1A 1E5, Canada, 1 7097772082, ewallack@mun.ca %K Aging %K Remote Assessment %K Monitoring %D 2018 %7 22.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 29472178 %R 10.2196/resprot.8744 %U http://www.researchprotocols.org/2018/2/e56/ %U https://doi.org/10.2196/resprot.8744 %U http://www.ncbi.nlm.nih.gov/pubmed/29472178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e423 %T 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 %A Boots,Lizzy MM %A de Vugt,Marjolein E %A Smeets,Claudia MJ %A Kempen,Gertrudis IJM %A Verhey,Frans RJ %+ Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Faculty of Health, Medicine and Life Sciences, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 43 3881994, l.boots@maastrichtuniversity.nl %K internet %K caregivers %K technology %K therapeutics %D 2017 %7 19.12.2017 %9 Original Paper %J J Med Internet Res %G English %X 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) %M 29258980 %R 10.2196/jmir.7666 %U http://www.jmir.org/2017/12/e423/ %U https://doi.org/10.2196/jmir.7666 %U http://www.ncbi.nlm.nih.gov/pubmed/29258980 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e239 %T 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 %A Huis in het Veld,Judith G %A Willemse,Bernadette M %A van Asch,Iris FM %A Groot Zwaaftink,Rob BM %A Verkade,Paul-Jeroen %A Veldhuijzen,Nienke J %A Verkaik,Renate %A Blom,Marco M %A Francke,Anneke L %+ Department of Public and Occupational Health, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 20 44 45 365, j.huisinhetveld@vumc.nl %K dementia %K family caregivers %K self-management %K behavior problems %K Internet %K eHealth %K RCT %K process evaluation %D 2017 %7 28.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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) %M 29183870 %R 10.2196/resprot.8365 %U http://www.researchprotocols.org/2017/11/e239/ %U https://doi.org/10.2196/resprot.8365 %U http://www.ncbi.nlm.nih.gov/pubmed/29183870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e223 %T Behavioral Interventions to Prevent or Delay Dementia: Protocol for a Randomized Comparative Effectiveness Study %A Smith,Glenn %A Chandler,Melanie %A Locke,Dona EC %A Fields,Julie %A Phatak,Vaishali %A Crook,Julia %A Hanna,Sherrie %A Lunde,Angela %A Morris,Miranda %A Graff-Radford,Michelle %A Hughes,Christine A %A Lepore,Susan %A Cuc,Andrea %A Caselli,Maria %A Hurst,Duane %A Wethe,Jennifer %A Francone,Andrea %A Eilertsen,Jeanne %A Lucas,Pauline %A Hoffman Snyder,Charlene %A Kuang,LeeAnn %A Becker,Marigrace %A Dean,Pamela %A Diehl,Nancy %A Lofquist,Marvin %A Vanderhook,Shirley %A Myles,Diana %A Cochran,Denise %+ Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr, Rm 3154, PO Box 10065, Gainesville, FL, 32610, United States, 1 3252736556, glennsmith@phhp.ufl.edu %K cognition disorders %K dementia %K secondary prevention %K behavioral research %D 2017 %7 27.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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) %M 29180344 %R 10.2196/resprot.8103 %U http://www.researchprotocols.org/2017/11/e223/ %U https://doi.org/10.2196/resprot.8103 %U http://www.ncbi.nlm.nih.gov/pubmed/29180344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e395 %T Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques %A Lumsden,Jim %A Skinner,Andy %A Coyle,David %A Lawrence,Natalia %A Munafo,Marcus %+ UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Rd, Bristol, BS8 1TU, United Kingdom, 44 117 92 88450, jim.lumsden@bristol.ac.uk %K behavioral research/methods %K games, experimental %K computers %K cognition %K Internet %K play and playthings/psychology %K boredom %K task performance and analysis %K executive function %K inhibition (psychology) %D 2017 %7 22.11.2017 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ22=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 η2=0.012). Conclusions: Our findings raise doubts about the ability of gamification to reduce attrition from longitudinal cognitive testing studies. %M 29167090 %R 10.2196/jmir.8473 %U http://www.jmir.org/2017/11/e395/ %U https://doi.org/10.2196/jmir.8473 %U http://www.ncbi.nlm.nih.gov/pubmed/29167090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e208 %T 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 %A Bravo,Gina %A Rodrigue,Claudie %A Thériault,Vincent %A Arcand,Marcel %A Downie,Jocelyn %A Dubois,Marie-France %A Kaasalainen,Sharon %A Hertogh,Cees M %A Pautex,Sophie %A Van den Block,Lieve %+ Faculty of Medicine and Health Sciences, Community Health Sciences, University of Sherbrooke, Z7-1017, 3001, North 12th Avenue, Sherbrooke, QC, J1H 5N4, Canada, 1 8198218000 ext 75376, Gina.Bravo@USherbrooke.ca %K euthanasia %K dementia %K decisional incapacity %K advance directive %K attitude %K survey %K Canada %D 2017 %7 13.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 29133281 %R 10.2196/resprot.8118 %U http://www.researchprotocols.org/2017/11/e208/ %U https://doi.org/10.2196/resprot.8118 %U http://www.ncbi.nlm.nih.gov/pubmed/29133281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e221 %T 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 %A Efthymiou,Areti %A Middleton,Nicos %A Charalambous,Andreas %A Papastavrou,Evridiki %+ Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, ZT3/3rd Floor, Vragadinou 15, Limassol, 3041, Cyprus, +357 25002285, arefthymiou@yahoo.com %K health literacy %K carers %K dementia %K ehealth %D 2017 %7 13.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 29133284 %R 10.2196/resprot.8080 %U http://www.researchprotocols.org/2017/11/e221/ %U https://doi.org/10.2196/resprot.8080 %U http://www.ncbi.nlm.nih.gov/pubmed/29133284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e358 %T Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia %A LaMonica,Haley M %A English,Amelia %A Hickie,Ian B %A Ip,Jerome %A Ireland,Catriona %A West,Stacey %A Shaw,Tim %A Mowszowski,Loren %A Glozier,Nick %A Duffy,Shantel %A Gibson,Alice A %A Naismith,Sharon L %+ Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 293510781, sharon.naismith@sydney.edu.au %K eHealth %K dementia %K mild cognitive impairment %K Internet %K Alzheimer disease %D 2017 %7 25.10.2017 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 29070481 %R 10.2196/jmir.7981 %U http://www.jmir.org/2017/10/e358/ %U https://doi.org/10.2196/jmir.7981 %U http://www.ncbi.nlm.nih.gov/pubmed/29070481 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e339 %T Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study %A Bayen,Eleonore %A Jacquemot,Julien %A Netscher,George %A Agrawal,Pulkit %A Tabb Noyce,Lynn %A Bayen,Alexandre %+ Pitie-Salpetriere Hospital - Assistance Publique Hôpitaux de Paris (APHP) & University Pierre et Marie Curie, Department of Neuro-Rehabilitation, Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, 47 Bd de l'Hôpital, Paris, 75013, France, 33 142160319, eleonore.bayen@gbhi.org %K video monitoring %K video review %K mobile app %K deep learning %K fall %K Alzheimer disease %K dementia %D 2017 %7 17.10.2017 %9 Original Paper %J J Med Internet Res %G English %X 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 (24×7), 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. %M 29042342 %R 10.2196/jmir.8095 %U http://www.jmir.org/2017/10/e339/ %U https://doi.org/10.2196/jmir.8095 %U http://www.ncbi.nlm.nih.gov/pubmed/29042342 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 9 %P e169 %T Effect of Caffeine on Attention and Alertness Measured in a Home-Setting, Using Web-Based Cognition Tests %A Pasman,Wilrike J %A Boessen,Ruud %A Donner,Yoni %A Clabbers,Nard %A Boorsma,André %+ TNO, Department of Microbiology and Systems Biology, Utrechtseweg 48, Zeist, 3704 HE, Netherlands, 31 888665129, wilrike.pasman@tno.nl %K caffeine %K at-home testing %K cognition %K EFSA claim %D 2017 %7 07.09.2017 %9 Original Paper %J JMIR Res Protoc %G English %X 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) %M 28882811 %R 10.2196/resprot.6727 %U http://www.researchprotocols.org/2017/9/e169/ %U https://doi.org/10.2196/resprot.6727 %U http://www.ncbi.nlm.nih.gov/pubmed/28882811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e307 %T Internet Searches and Their Relationship to Cognitive Function in Older Adults: Cross-Sectional Analysis %A Austin,Johanna %A Hollingshead,Kristy %A Kaye,Jeffrey %+ Department of Neurology, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR, 97239, United States, 1 503 418 9328, peterjo@ohsu.edu %K Internet %K geriatrics %K cognition %K executive function %D 2017 %7 06.09.2017 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 28877864 %R 10.2196/jmir.7671 %U http://www.jmir.org/2017/9/e307/ %U https://doi.org/10.2196/jmir.7671 %U http://www.ncbi.nlm.nih.gov/pubmed/28877864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e301 %T Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review %A Bateman,Daniel R %A Srinivas,Bhavana %A Emmett,Thomas W %A Schleyer,Titus K %A Holden,Richard J %A Hendrie,Hugh C %A Callahan,Christopher M %+ Indiana University Center for Aging Research, Regenstrief Institute, Inc, 1101 West 10th Street, Indianapolis, IN, 46202, United States, 1 317 274 9334, darbate@iupui.edu %K mHealth %K mobile health %K applications %K Alzheimer disease %K dementia %K systematic review %D 2017 %7 30.08.2017 %9 Review %J J Med Internet Res %G English %X 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) %M 28855146 %R 10.2196/jmir.7814 %U http://www.jmir.org/2017/8/e301/ %U https://doi.org/10.2196/jmir.7814 %U http://www.ncbi.nlm.nih.gov/pubmed/28855146 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 3 %P e16 %T Designing Serious Computer Games for People With Moderate and Advanced Dementia: Interdisciplinary Theory-Driven Pilot Study %A Tziraki,Chariklia %A Berenbaum,Rakel %A Gross,Daniel %A Abikhzer,Judith %A Ben-David,Boaz M %+ Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, PO Box 167, Herzliya, 4610101, Israel, 972 9 960 2429, boaz.ben.david@idc.ac.il %K serious games %K dementia %K functionality %K learning in context %K speed of processing %D 2017 %7 31.07.2017 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 28760730 %R 10.2196/games.6514 %U http://games.jmir.org/2017/3/e16/ %U https://doi.org/10.2196/games.6514 %U http://www.ncbi.nlm.nih.gov/pubmed/28760730 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e244 %T Studying Scale-Up and Spread as Social Practice: Theoretical Introduction and Empirical Case Study %A Shaw,James %A Shaw,Sara %A Wherton,Joseph %A Hughes,Gemma %A Greenhalgh,Trisha %+ Women's College Hospital, Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S1B2, Canada, 1 +16473828505, jay.shaw@wchospital.ca %K sociology %K medical %K technological innovations %K telemedicine %K health policy %K mHealth %D 2017 %7 07.07.2017 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 28687532 %R 10.2196/jmir.7482 %U http://www.jmir.org/2017/7/e244/ %U https://doi.org/10.2196/jmir.7482 %U http://www.ncbi.nlm.nih.gov/pubmed/28687532 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e68 %T Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study %A Jongstra,Susan %A Wijsman,Liselotte Willemijn %A Cachucho,Ricardo %A Hoevenaar-Blom,Marieke Peternella %A Mooijaart,Simon Pieter %A Richard,Edo %+ Academic Medical Center, Department of Neurology, University of Amsterdam, Meiberdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205663446, s.jongstra@amc.uva.nl %K telemedicine %K cognition %K neuropsychological tests %D 2017 %7 25.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 ρ=.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 (ρ=.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. %M 28546139 %R 10.2196/mhealth.6939 %U http://mhealth.jmir.org/2017/5/e68/ %U https://doi.org/10.2196/mhealth.6939 %U http://www.ncbi.nlm.nih.gov/pubmed/28546139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e60 %T 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 %A Boomsma,Jooske Marije Funke %A Exalto,Lieza Geertje %A Barkhof,Frederik %A van den Berg,Esther %A de Bresser,Jeroen %A Heinen,Rutger %A Koek,Huiberdina Lena %A Prins,Niels Daniël %A Scheltens,Philip %A Weinstein,Henry Chanoch %A van der Flier,Wiesje Maria %A Biessels,Geert Jan %+ Department of Neurology, Neurosurgery and Neuropsychology, Brain Centre Rudolf Magnus Institute, University Medical Centre Utrecht, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 88 7556866, G.J.Biessels@umcutrecht.nl %K vascular cognitive impairment %K memory clinic %K small vessel disease %K vascular disease %K prognosis %K dementia %D 2017 %7 19.04.2017 %9 Editorial %J JMIR Res Protoc %G English %X 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. %M 28428166 %R 10.2196/resprot.6864 %U http://www.researchprotocols.org/2017/4/e60/ %U https://doi.org/10.2196/resprot.6864 %U http://www.ncbi.nlm.nih.gov/pubmed/28428166 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e56 %T Comparing Crowdsourcing and Friendsourcing: A Social Media-Based Feasibility Study to Support Alzheimer Disease Caregivers %A Bateman,Daniel Robert %A Brady,Erin %A Wilkerson,David %A Yi,Eun-Hye %A Karanam,Yamini %A Callahan,Christopher M %+ Indiana University Center for Aging Research, 1101 West Tenth Street, Indianapolis, IN, 46202, United States, 1 317 274 9334, darbate@iupui.edu %K Alzheimer disease %K Alzheimer disease and related dementias %K caregivers %K mobile health %K social media %K crowdsourcing %K friendsourcing %K emotional support %K informational support %K online support %D 2017 %7 10.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 28396304 %R 10.2196/resprot.6904 %U http://www.researchprotocols.org/2017/4/e56/ %U https://doi.org/10.2196/resprot.6904 %U http://www.ncbi.nlm.nih.gov/pubmed/28396304 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e8 %T Effects of Video Game Training on Behavioral and Electrophysiological Measures of Attention and Memory: Protocol for a Randomized Controlled Trial %A Ballesteros,Soledad %A Mayas,Julia %A Ruiz-Marquez,Eloisa %A Prieto,Antonio %A Toril,Pilar %A Ponce de Leon,Laura %A de Ceballos,Maria L %A Reales Avilés,José Manuel %+ Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Facultad de Psicología, Juan del Rosal, 10, Madrid,, Spain, 34 91398 62 27, mballesteros@psi.uned.es %K attention %K C-reactive protein %K cognitive training %K healthy aging %K inflammation %K electrophysiology %K video games %K working memory %D 2017 %7 24.01.2017 %9 Protocol %J JMIR Res Protoc %G English %X 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) %M 28119279 %R 10.2196/resprot.6570 %U http://www.researchprotocols.org/2017/1/e8/ %U https://doi.org/10.2196/resprot.6570 %U http://www.ncbi.nlm.nih.gov/pubmed/28119279 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 4 %N 1 %P e1 %T Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics %A Meiland,Franka %A Innes,Anthea %A Mountain,Gail %A Robinson,Louise %A van der Roest,Henriëtte %A García-Casal,J Antonio %A Gove,Dianne %A Thyrian,Jochen René %A Evans,Shirley %A Dröes,Rose-Marie %A Kelly,Fiona %A Kurz,Alexander %A Casey,Dympna %A Szcześniak,Dorota %A Dening,Tom %A Craven,Michael P %A Span,Marijke %A Felzmann,Heike %A Tsolaki,Magda %A Franco-Martin,Manuel %+ Department of Psychiatry, VU University medical centre, AJ Ernststraat 1187, Amsterdam, 1081 HL, Netherlands, 31 207885623, fj.meiland@vumc.nl %K dementia %K technology %K evaluation studies %K diffusion of innovation %K ethics %D 2017 %7 16.01.2017 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X 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. %M 28582262 %R 10.2196/rehab.6376 %U http://rehab.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/rehab.6376 %U http://www.ncbi.nlm.nih.gov/pubmed/28582262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e3 %T The Use of Motion-Based Technology for People Living With Dementia or Mild Cognitive Impairment: A Literature Review %A Dove,Erica %A Astell,Arlene J %+ Research & Academics, Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada, 1 905 430 4055 ext 6313, dovee@ontarioshores.ca %K dementia %K mild cognitive impairment %K technology %K review %D 2017 %7 11.01.2017 %9 Review %J J Med Internet Res %G English %X 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. %M 28077346 %R 10.2196/jmir.6518 %U http://www.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/jmir.6518 %U http://www.ncbi.nlm.nih.gov/pubmed/28077346 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e93 %T The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial %A Hartin,Phillip J %A Nugent,Chris D %A McClean,Sally I %A Cleland,Ian %A Tschanz,JoAnn T %A Clark,Christine J %A Norton,Maria C %+ Computer Science Research Institute, Ulster University, Room 16J26, University of Ulster, Newtownabbey, BT37 0QB, United Kingdom, 44 28 9036 8840, pj.hartin@ulster.ac.uk %K behavior %K health behavior %K behavior change %K motivation %K Alzheimer disease %K smartphone %D 2016 %7 02.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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) %M 27485822 %R 10.2196/mhealth.4878 %U http://mhealth.jmir.org/2016/3/e93/ %U https://doi.org/10.2196/mhealth.4878 %U http://www.ncbi.nlm.nih.gov/pubmed/27485822 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e144 %T Evaluation of the Digital Alzheimer Center: Testing Usability and Usefulness of an Online Portal for Patients with Dementia and Their Carers %A Hattink,Bart %A Droes,Rose-Marie %A Sikkes,Sietske %A Oostra,Ellen %A Lemstra,Afina W %+ VU University Medical Center, Department of Psychiatry, Postbus 74077, Amsterdam, 1070 BB, Netherlands, 31 207885622, b.hattink@vumc.nl %K dementia %K Alzheimer disease %K patient portal %K electronic health record %K eHealth %D 2016 %7 21.07.2016 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 27444209 %R 10.2196/resprot.5040 %U http://www.researchprotocols.org/2016/3/e144/ %U https://doi.org/10.2196/resprot.5040 %U http://www.ncbi.nlm.nih.gov/pubmed/27444209 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e12 %T Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia %A Wiloth,Stefanie %A Lemke,Nele %A Werner,Christian %A Hauer,Klaus %+ AGAPLESION Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany, Research Department, Rohrbacher Straße 149, Heidelberg, 69126, Germany, 49 1739471446, stefanie.wiloth@gmail.com %K serious games %K computerized assessment %K validation %K motor-cognitive functions %K elderly %K older adults %K cognitive impairment %K dementia %D 2016 %7 18.7.2016 %9 Original Paper %J JMIR Serious Games %G English %X 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±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. %M 27432746 %R 10.2196/games.5696 %U http://games.jmir.org/2016/2/e12/ %U https://doi.org/10.2196/games.5696 %U http://www.ncbi.nlm.nih.gov/pubmed/27432746 %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 3 %N 1 %P e6 %T Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers %A Martínez-Alcalá,Claudia I %A Pliego-Pastrana,Patricia %A Rosales-Lagarde,Alejandra %A Lopez-Noguerola,JS %A Molina-Trinidad,Eva M %+ Consejo Nacional de Ciencia y Tecnología, Research Fellow, Av. Insurgentes Sur 1582, Col. Crédito Constructor, Del. Benito Juárez, Ciudad de Mexico, 03940, Mexico, 52 (771) 71 72 000 ext 4332, cimartinezal@conacyt.mx %K information and communication technologies %K eHealth %K elderly %K caregiver %K Alzheimer's disease %K systematic review %D 2016 %7 02.05.2016 %9 Review %J JMIR Rehabil Assist Technol %G English %X 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. %M 28582258 %R 10.2196/rehab.5226 %U http://rehab.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/rehab.5226 %U http://www.ncbi.nlm.nih.gov/pubmed/28582258 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e47 %T Usefulness of a Tailored eHealth Service for Informal Caregivers and Professionals in the Dementia Treatment and Care Setting: The eHealthMonitor Dementia Portal %A Schaller,Sandra %A Marinova-Schmidt,Velislava %A Setzer,Manuela %A Kondylakis,Haridimos %A Griebel,Lena %A Sedlmayr,Martin %A Graessel,Elmar %A Maler,Juan Manuel %A Kirn,Stefan %A Kolominsky-Rabas,Peter L %+ Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Friedrich-Alexander-University of Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany, 49 9131 8534167, sandra.schaller@uk-erlangen.de %K eHealth %K web portal %K decision aid %K personalized support %K dementia %K Alzheimer’s disease %K informal caregiver %K medical professional %D 2016 %7 05.04.2016 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 27050401 %R 10.2196/resprot.4354 %U http://www.researchprotocols.org/2016/2/e47/ %U https://doi.org/10.2196/resprot.4354 %U http://www.ncbi.nlm.nih.gov/pubmed/27050401 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e33 %T 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 %A Boots,Lizzy MM %A de Vugt,Marjolein E %A Withagen,Hanneke EJ %A Kempen,Gertrudis IJM %A Verhey,Frans RJ %+ School for Mental Health and Neurosciences and Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 3881994, l.boots@maastrichtuniversity.nl %K carers %K dementia %K focus groups %K Internet %K psychosocial support systems %D 2016 %7 01.03.2016 %9 Original Paper %J JMIR Res Protoc %G English %X 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). %M 26932438 %R 10.2196/resprot.5142 %U http://www.researchprotocols.org/2016/1/e33/ %U https://doi.org/10.2196/resprot.5142 %U http://www.ncbi.nlm.nih.gov/pubmed/26932438 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e264 %T Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan %A Wang,Ho-Wei %A Chen,Duan-Rung %A Yu,Hsiao-Wei %A Chen,Ya-Mei %+ Institute of Health Policy and Management, National Taiwan University, 6F, Number 17, Xu-Zhou Road, Taipei, 100, Taiwan, 886 2 33668063, chenyamei@ntu.edu.tw %K dementia %K Alzheimer’s disease %K Google Trends %K big data %K incidence %K early detection %K self-diagnosis %K Internet search %K health-seeking behaviors %D 2015 %7 19.11.2015 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 26586281 %R 10.2196/jmir.4516 %U http://www.jmir.org/2015/11/e264/ %U https://doi.org/10.2196/jmir.4516 %U http://www.ncbi.nlm.nih.gov/pubmed/26586281 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e130 %T 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 %A Aalbers,Teun %A Baars,Maria AE %A Qin,Li %A de Lange,Annet %A Kessels,Roy PC %A Olde Rikkert,Marcel GM %+ Department of Geriatric Medicine, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, Netherlands, 31 243619807, teun.aalbers@radboudumc.nl %K cognition %K healthy lifestyle %K eHealth %K internet %K prevention %K applied games %K protocol %D 2015 %7 10.11.2015 %9 Original Paper %J JMIR Res Protoc %G English %X 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) %M 26554496 %R 10.2196/resprot.4468 %U http://www.researchprotocols.org/2015/4/e130/ %U https://doi.org/10.2196/resprot.4468 %U http://www.ncbi.nlm.nih.gov/pubmed/26554496 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e45 %T 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 %A Yu,Ruby %A Hui,Elsie %A Lee,Jenny %A Poon,Dawn %A Ng,Ashley %A Sit,Kitty %A Ip,Kenny %A Yeung,Fannie %A Wong,Martin %A Shibata,Takanori %A Woo,Jean %+ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Room 124021, 10/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, , China (Hong Kong), 852 26322190, rubyyu@cuhk.edu.hk %K dementia %K elderly %K PARO %K randomized controlled trial %K robot-assisted therapy %K socially assistive robots %D 2015 %7 01.05.2015 %9 Protocol %J JMIR Res Protoc %G English %X 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). %M 25934173 %R 10.2196/resprot.4189 %U http://www.researchprotocols.org/2015/2/e45/ %U https://doi.org/10.2196/resprot.4189 %U http://www.ncbi.nlm.nih.gov/pubmed/25934173 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e4 %T Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction %A O'Connor,Elodie %A Farrow,Maree %A Hatherly,Chris %+ Alzheimer's Australia, 155 Oak St, Parkville, 3052, Australia, 61 3 9816 5795, maree.farrow@alzheimers.org.au %K dementia %K Alzheimer %K engagement %K health communication %K Internet %K intervention %K mobile phone %K risk reduction behavior %K user perceptions %K mhealth %D 2014 %7 22.12.2014 %9 Original Paper %J JMIR Mental Health %G English %X 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. %M 26543904 %R 10.2196/mental.3654 %U http://mental.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/mental.3654 %U http://www.ncbi.nlm.nih.gov/pubmed/26543904