TY - JOUR AU - Louis, Lina-Estelle AU - Moussaoui, Saïd AU - Ravoux, Sébastien AU - Milleville-Pennel, Isabelle PY - 2025/4/10 TI - Encouraging the Voluntary Mobilization of Mental Resources by Manipulating Task Design: Explorative Study JO - JMIR Form Res SP - e63491 VL - 9 KW - visual game-like elements KW - gamification KW - multiplicity of cognitive functions KW - cognitive tasks KW - perceived playfulness KW - mental workload KW - performance KW - cognitive training KW - aging KW - mental effort KW - cognitive function KW - cognitive skills KW - cognitive tests N2 - Background: Cognitive training is increasingly being considered and proposed as a solution for several pathologies, particularly those associated with aging. However, trainees need to be willing to invest enough mental effort to succeed and make progress. Objective: In this study, we explore how gamification in a narrative context (ie, the addition of visual game-like elements [GLEs] embedded in real-world contexts) could contribute increase in perceived playfulness (PP) and voluntary mental effort allocated to a cognitive task. In such context, narrative elements and GLEs can be designed to align with a commonly relatable scenario (like simulating fishing or gardening activity) to ground the task in familiar, real-world contexts. We also consider if the supposed effect of GLEs on PP and voluntary mental effort could endure while manipulating an intrinsic variable of the task (ie, by increasing cognitive solicitation). Methods: In total, 20 participants (average age 33.6, SD 8.6 y) took part in 3 cognitive tasks proposed in a numerical format: a classic version of the Corsi test (Classic Corsi, a spatial memory task), a playful version of the Classic Corsi test (Playful Corsi), with added visual GLEs in a narrative context, and a playful version of the Classic Corsi test with added cognitive solicitation, that is, mental motor inhibition (Playful Corsi Multi). We assessed the impact of visual GLEs and cognitive solicitation on PP (1 question) and mental workload (MWL) using NASA-Task Load Index (NASA-TLX) and workload profile (WP) questionnaires. Results: Results showed that PP was not influenced by interface?s playful characteristics (Classic Corsi [mean 62.4, SD 8.8] vs Playful Corsi [mean 66, SD 8.8]; W=77; P=.30) but decreased the time necessary to complete the task (Classic Corsi [mean 10.7, SD 2.1 s] vs Playful Corsi [mean 6.8, SD 1.6 s]; W=209; P<.001) as well as performance (Classic Corsi [mean 92.4, SD 9.1] vs Playful Corsi [mean 88.2, SD 11.3]; W=140.5; P=.02). So, possibly, visual GLEs could raise the stakes of the task slightly and implicitly encourage people to go a bit faster. Furthermore, visual GLEs increased MWL regarding attentional resources (assessed by WP: Classic Corsi [mean 52.4, SD 10.9] vs Playful Corsi [mean 65.8, SD 10.9]; W=27.5; P=.04), while manipulating cognitive solicitation impacted MWL when linked to task requirements (assessed by NASA-TLX: Playful Corsi [mean 54.2, SD 9.4] vs Playful Corsi Multi [mean 67.5, SD 9.4]; W=35.5; P=.01) without impacting the performance to the task (Playful Corsi [mean 83.8, SD 13.9] vs Playful Corsi Multi [mean 94, SD 5.5]; W=27; P=.007). Thus, working on the way cognitive functions are solicited would be wiser than adding visual GLEs to improve users? voluntary mental effort while preserving performance. Conclusion: These results offer valuable insights to improve users? experience during gamified cognitive tasks and serious games. UR - https://formative.jmir.org/2025/1/e63491 UR - http://dx.doi.org/10.2196/63491 ID - info:doi/10.2196/63491 ER - TY - JOUR AU - Zhang, Shangyang AU - Wu, Min AU - Sun, Ruini AU - Cui, Changjie AU - Zhang, Ziqing AU - Liao, Jing AU - Gong, Ni PY - 2025/3/25 TI - 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 JO - J Med Internet Res SP - e66393 VL - 27 KW - digital cognitive training KW - discontinuous usage behavior KW - acceptance KW - mild cognitive impairment KW - qualitative study N2 - 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. UR - https://www.jmir.org/2025/1/e66393 UR - http://dx.doi.org/10.2196/66393 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66393 ER - TY - JOUR AU - Li, Jiaying AU - He, Rendong AU - Hsu, Erh-Chi AU - Li, Junxin PY - 2025/3/19 TI - Network Analysis of Key Instrumental Activities of Daily Living and Cognitive Domains for Targeted Intervention in US Older Adults Without Dementia: Cross-Sectional Study JO - JMIR Aging SP - e67632 VL - 8 KW - cognition function KW - older adults KW - intervention targets KW - elder KW - elderly KW - cognitive impairment KW - stimulating activity KW - instrumental activities of daily living KW - IADL KW - daily living activity KW - cognitive domain KW - non-demented KW - cognitive network KW - holistic cognition KW - holistic cognition function KW - network comparison KW - central variables KW - bridge variables KW - network analysis N2 - 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. UR - https://aging.jmir.org/2025/1/e67632 UR - http://dx.doi.org/10.2196/67632 ID - info:doi/10.2196/67632 ER - TY - JOUR AU - Fan, Wenqi AU - Zhao, Rui AU - Liu, Xiaoxia AU - Ge, Lina PY - 2025/3/10 TI - Intelligent Robot Interventions for People With Dementia: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e59892 VL - 27 KW - intelligent robot KW - artificial intelligence KW - dementia KW - agitation KW - anxiety KW - meta-analysis N2 - 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 UR - https://www.jmir.org/2025/1/e59892 UR - http://dx.doi.org/10.2196/59892 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59892 ER - TY - JOUR AU - Everard, Gauthier AU - Declerck, Louise AU - Lejeune, Thierry AU - Edwards, Gareth Martin AU - Bogacki, Justine AU - Reiprich, Cléo AU - Delvigne, Kelly AU - Legrain, Nicolas AU - Batcho, Sebiyo Charles PY - 2025/3/3 TI - A Self-Adaptive Serious Game to Improve Motor Learning Among Older Adults in Immersive Virtual Reality: Short-Term Longitudinal Pre-Post Study on Retention and Transfer JO - JMIR Aging SP - e64004 VL - 8 KW - virtual reality KW - aged KW - learning KW - upper extremity KW - video games KW - kinematics N2 - Background: Despite their potential, the use of serious games within immersive virtual reality (iVR) for enhancing motor skills in older adults remains relatively unexplored. In this study, we developed a self-adaptive serious game in iVR called REAsmash-iVR. This game involves swiftly locating and striking a digital mole presented with various distractors. Objective: This short-term longitudinal pre-post study aims to evaluate REAsmash-iVR?s efficacy in promoting motor learning in older adults. Specifically, we seek to determine the transfer and retention of motor learning achieved through REAsmash-iVR to other iVR tasks. Methods: A total of 20 older adults participated in the study, engaging with REAsmash-iVR over 7 consecutive days. The evaluation included iVR tests such as KinematicsVR and a VR adaptation of the Box and Block Test (BBT-VR). KinematicsVR tasks included drawing straight lines and circles as fast and as accurately as possible, while BBT-VR required participants to move digital cubes as quickly as possible within 60 seconds. Assessments were conducted before and after the intervention, with a follow-up at 1 week post intervention. The primary outcome focused on evaluating the impact of REAsmash-iVR on speed-accuracy trade-off during KinematicsVR tasks. Secondary outcomes included analyzing movement smoothness, measured by spectral arc length, and BBT-VR scores. Results: Results revealed significant improvements in speed-accuracy trade-off post intervention compared to that before the intervention, with notable retention of skills for straight lines (t19=5.46; P<.001; Cohen d=1.13) and circle drawing (t19=3.84; P=.001; Cohen d=0.787). Likewise, there was a significant enhancement in spectral arc length, particularly for circle drawing (?²2=11.2; P=.004; ?2=0.23), but not for straight-line drawing (?²2=2.1; P=.35; ?2=0.003). Additionally, participants demonstrated transfer with significant improvement (q=5.26; P<.001; Cohen r=0.678) and retention (q=6.82; P<.001; Cohen r=0.880) in BBT-VR skills. Conclusions: These findings provide perspectives for the use of iVR to improve motor learning in older adults through delivering self-adaptive serious games targeting motor and cognitive functions. Trial Registration: ClinicalTrials.gov NCT04694833; https://clinicaltrials.gov/study/NCT04694833 UR - https://aging.jmir.org/2025/1/e64004 UR - http://dx.doi.org/10.2196/64004 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053708 ID - info:doi/10.2196/64004 ER - TY - JOUR AU - Torabgar, Melika AU - Figeys, Mathieu AU - Esmail, Shaniff AU - Stroulia, Eleni AU - Ríos Rincón, M. Adriana PY - 2025/3/3 TI - Machine Learning Analysis of Engagement Behaviors in Older Adults With Dementia Playing Mobile Games: Exploratory Study JO - JMIR Serious Games SP - e54797 VL - 13 KW - dementia KW - gaming KW - engagement KW - cognition KW - machine learning KW - games KW - cognitive KW - screening KW - classification KW - Alzheimer disease KW - gerontology KW - geriatric KW - older adult KW - elderly KW - aging N2 - 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 ?² 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. UR - https://games.jmir.org/2025/1/e54797 UR - http://dx.doi.org/10.2196/54797 ID - info:doi/10.2196/54797 ER - TY - JOUR AU - Jornkokgoud, Khanitin AU - Makmee, Pattrawadee AU - Wongupparaj, Peera AU - Grecucci, Alessandro PY - 2025/2/21 TI - Tablet- and Group-Based Multicomponent Cognitive Stimulation for Older Adults With Mild Cognitive Impairment: Single-Group Pilot Study and Protocol for Randomized Controlled Trial JO - JMIR Res Protoc SP - e64465 VL - 14 KW - computerized cognitive stimulation KW - multisensory integration KW - cognitive decline KW - aging KW - electroencephalography KW - randomized controlled trial KW - RCT KW - protocol KW - cognitive stimulation KW - mild cognitive impairment KW - cognitive KW - cognition KW - cognitive simulation therapy KW - CST KW - MCI KW - tablet KW - effectiveness KW - pilot study KW - neuropsychological tests KW - behavioral KW - emotional N2 - 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 UR - https://www.researchprotocols.org/2025/1/e64465 UR - http://dx.doi.org/10.2196/64465 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64465 ER - TY - JOUR AU - Levinson, J. Anthony AU - Ayers, Stephanie AU - Clark, Sandra AU - Woodburn, Rebekah AU - Dobbins, Maureen AU - Duarte, Dante AU - Grad, Roland AU - Kates, Nick AU - Marr, Sharon AU - Oliver, Doug AU - Papaioannou, Alexandra AU - Saperson, Karen AU - Siu, Henry AU - Strudwick, Gillian AU - Sztramko, Richard AU - Neil-Sztramko, Sarah PY - 2025/1/27 TI - Internet-Based Dementia Prevention Intervention (DementiaRisk): Protocol for a Randomized Controlled Trial and Knowledge Translation JO - JMIR Res Protoc SP - e64718 VL - 14 KW - web-based intervention KW - internet KW - eHealth KW - dementia risk KW - dementia prevention KW - Alzheimer disease KW - education and training KW - clinical trial KW - knowledge translation KW - public health KW - health literacy KW - e-learning N2 - 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 UR - https://www.researchprotocols.org/2025/1/e64718 UR - http://dx.doi.org/10.2196/64718 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64718 ER - TY - JOUR AU - Hadar Souval, Dorit AU - Haber, Yuval AU - Tal, Amir AU - Simon, Tomer AU - Elyoseph, Tal AU - Elyoseph, Zohar PY - 2025/1/15 TI - Transforming Perceptions: Exploring the Multifaceted Potential of Generative AI for People With Cognitive Disabilities JO - JMIR Neurotech SP - e64182 VL - 4 KW - generative artificial intelligence KW - cognitive disability KW - social participation KW - AI ethics KW - assistive technology KW - cognitive disorder KW - societal barriers KW - social inclusion KW - disability study KW - social mirror KW - cognitive partner KW - empowerment KW - user involvement KW - GenAI KW - artificial intelligence KW - neurotechnology KW - neuroinformatics KW - digital health KW - health informatics KW - neuroscience KW - mental health KW - computer science KW - machine learning N2 - 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. UR - https://neuro.jmir.org/2025/1/e64182 UR - http://dx.doi.org/10.2196/64182 ID - info:doi/10.2196/64182 ER - TY - JOUR AU - Kwek, Peng Siong AU - Leong, Ying Qiao AU - Lee, Vien V. AU - Lau, Yin Ni AU - Vijayakumar, Smrithi AU - Ng, Ying Wei AU - Rai, Bina AU - Raczkowska, Natalia Marlena AU - Asplund, L. Christopher AU - Remus, Alexandria AU - Ho, Dean PY - 2025/1/13 TI - Exploring the General Acceptability and User Experience of a Digital Therapeutic for Cognitive Training in a Singaporean Older Adult Population: Qualitative Study JO - JMIR Form Res SP - e63568 VL - 9 KW - older adults KW - cognitive training KW - digital therapeutic KW - DTx KW - remote KW - usability KW - acceptance KW - interviews KW - gerontology KW - geriatric KW - elderly KW - experiences KW - attitudes KW - opinions KW - perceptions KW - perspectives KW - interview KW - cognition KW - digital health KW - qualitative KW - thematic N2 - 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. UR - https://formative.jmir.org/2025/1/e63568 UR - http://dx.doi.org/10.2196/63568 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63568 ER - TY - JOUR AU - Yang, Qin AU - Zhang, Liuxin AU - Chang, Fangyuan AU - Yang, Hongyi AU - Chen, Bin AU - Liu, Zhao PY - 2025/1/10 TI - Virtual Reality Interventions for Older Adults With Mild Cognitive Impairment: Systematic Review and Meta-Analysis of Randomized Controlled Trials JO - J Med Internet Res SP - e59195 VL - 27 KW - Alzheimer disease KW - virtual reality KW - VR KW - mild cognitive impairment KW - meta-analysis KW - health care KW - cognitive function KW - memory KW - attention KW - executive function KW - older adults N2 - 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. UR - https://www.jmir.org/2025/1/e59195 UR - http://dx.doi.org/10.2196/59195 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59195 ER - TY - JOUR AU - Kwan, Cho Rick Yiu AU - Law, Sze Queenie Pui AU - Tsang, Yee Jenny Tsun AU - Lam, Hin Siu AU - Wang, To Kam AU - Sin, Kan Olive Shuk AU - Cheung, Ki Daphne Sze PY - 2024/12/13 TI - 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 JO - JMIR Rehabil Assist Technol SP - e60155 VL - 11 KW - cognitive frailty KW - gamification KW - health education KW - Mediterranean diet KW - home based KW - cognitive training KW - older adults KW - geriatric KW - elderly KW - cognitive function KW - intervention KW - nutritional education KW - cognitive impairment KW - dementia N2 - 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 UR - https://rehab.jmir.org/2024/1/e60155 UR - http://dx.doi.org/10.2196/60155 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60155 ER - TY - JOUR AU - Klein, Melina AU - von Bosse, Alexa AU - Kunze, Christophe PY - 2024/12/10 TI - The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study JO - JMIR Aging SP - e62689 VL - 7 KW - touch-based digital technology KW - gerontology KW - geriatric KW - older KW - elderly KW - aging KW - aged KW - tablet-based technology KW - tablet KW - digital care application KW - mHealth KW - mobile health KW - app KW - health app KW - home care setting KW - caring relatives KW - dementia KW - MCI KW - Alzheimer KW - mild cognitive impairment KW - cognition KW - prototype KW - digital health KW - telehealth KW - memory loss KW - patient care KW - patient health KW - patient support N2 - 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. UR - https://aging.jmir.org/2024/1/e62689 UR - http://dx.doi.org/10.2196/62689 ID - info:doi/10.2196/62689 ER - TY - JOUR AU - Bruni, Francesca AU - Mancuso, Valentina AU - Panigada, Jonathan AU - Stramba-Badiale, Marco AU - Cipresso, Pietro AU - Pedroli, Elisa PY - 2024/12/5 TI - Exploring How Older Adults Experience semAPP, a 360° Media?Based Tool for Memory Assessment: Qualitative Study JO - JMIR Aging SP - e56796 VL - 7 KW - assessment KW - virtual reality KW - 360-degree videos KW - user experience KW - memory KW - aging KW - psycho gerontology N2 - 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. UR - https://aging.jmir.org/2024/1/e56796 UR - http://dx.doi.org/10.2196/56796 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56796 ER - TY - JOUR AU - Zhou, Wu AU - Feng, HaiXia AU - Tao, Hua AU - Sun, Hui AU - Zhang, TianTian AU - Wang, QingXia AU - Zhang, Li PY - 2024/11/19 TI - Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis JO - JMIR Form Res SP - e59572 VL - 8 KW - stroke KW - cognitive dysfunction KW - analysis of associated factors KW - MMSE KW - Mini-Mental State Examination KW - status survey KW - cognitive KW - survey KW - cognitive impairment KW - cross-sectional study KW - cross sectional KW - stroke patients KW - cognition KW - education N2 - 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. UR - https://formative.jmir.org/2024/1/e59572 UR - http://dx.doi.org/10.2196/59572 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59572 ER - TY - JOUR AU - de Vette, Frederiek AU - Ruiz-Rodriguez, Aurora AU - Tabak, Monique AU - Oude Nijeweme-d'Hollosy, Wendy AU - Hermens, Hermie AU - Vollenbroek-Hutten, Miriam PY - 2024/11/8 TI - Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process JO - JMIR Form Res SP - e13723 VL - 8 KW - game based KW - gamification KW - game KW - eHealth KW - telemedicine KW - development KW - design KW - engagement KW - game preferences KW - older adults KW - self-management KW - prototyping KW - evaluations KW - creative N2 - Background: Games are increasingly used in eHealth as a strategy for user engagement. There is an enormous diversity of end users and objectives targeted by eHealth. Hence, identifying game content that drives and sustains engagement is challenging. More openness in the game design process and motivational strategies could aid researchers and designers of future game-based apps. Objective: This study aims to provide insights into our approach to develop game-based eHealth in practice with a case study (Personalised ICT Supported Services for Independent Living and Active Ageing [PERSSILAA]). PERSSILAA is a self-management platform that aims to counter frailty by offering training modules to older adults in the domains of healthy nutrition and physical and cognitive training to maintain a healthy lifestyle. We elaborate on the entire game design process and show the motivational strategies applied. Methods: We introduce four game design phases in the process toward game-based eHealth: (1) end-user research, (2) conceptualization, (3) creative design, and (4) refinement (ie, prototyping and evaluations). Results: First, 168 participants participated in end-user research, resulting in an overview of their preferences for game content and a set of game design recommendations. We found that conventional games popular among older adults do not necessarily translate well into engaging concepts for eHealth. Recommendations include focusing game concepts on thinking, problem-solving, variation, discovery, and achievement and using high-quality aesthetics. Second, stakeholder sessions with development partners resulted in strategies for long-term engagement using indicators of user performance on the platform?s training modules. These performance indicators, for example, completed training sessions or exercises, form the basis for game progression. Third, results from prior phases were used in creative design to create the game ?Stranded!? The user plays a person who is shipwrecked who must gather parts for a life raft by completing in-game objectives. Finally, iterative prototyping resulted in the final prototype of the game-based app. A total of 35 older adults participated using simulated training modules. End users scored appreciation (74/100), ease of use (73/100), expected effectivity and motivation (62/100), fun and pleasantness of using the app (75/100), and intended future use (66/100), which implies that the app is ready for use by a larger population. Conclusions: The study resulted in a game-based app for which the entire game design process within eHealth was transparently documented and where engagement strategies were based on extensive user research. Our user evaluations indicate that the strategies for long-term engagement led to game content that was perceived as engaging by older adults. As a next step, research is needed on the user experience and actual engagement with the game to support the self-management of older adults, followed by clinical studies on its added value. UR - https://formative.jmir.org/2024/1/e13723 UR - http://dx.doi.org/10.2196/13723 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13723 ER - TY - JOUR AU - Kamnardsiri, Teerawat AU - Kumfu, Sirintip AU - Munkhetvit, Peeraya AU - Boripuntakul, Sirinun AU - Sungkarat, Somporn PY - 2024/10/29 TI - Home-Based, Low-Intensity, Gamification-Based, Interactive Physical-Cognitive Training for Older Adults Using the ADDIE Model: Design, Development, and Evaluation of User Experience JO - JMIR Serious Games SP - e59141 VL - 12 KW - exergame KW - physical-cognitive training KW - computer-based interventions KW - gamification KW - older adults KW - instructional design model KW - low-intensity N2 - Background: Declines in physical and cognitive function are natural biological processes, leading to an increased risk of falls. Promising evidence suggests that combined physical-cognitive exercise has beneficial effects in improving both physical and cognitive health. Although moderate-to-high exercise intensity is commonly recommended, it might be impractical for older adults facing physical limitations or contraindications. Thus, low-intensity exercise is a viable option. The main barriers to engaging in exercise in older adults include transportation, time, motivation, and enjoyment. To overcome these challenges, a home-based, gamification-based training system may provide an effective approach to enhance exercise adherence. Objective: This study aimed to develop and evaluate the usability of a low-intensity, gamification-based, interactive physical-cognitive exercise for older adults in a home-based setting. Methods: The prototype of a game-based physical-cognitive exercise was created following the ADDIE model (analysis, design, development, implementation, and evaluation) and assessed for user experience in older adults. A total of 15 older adults engaged in the game-based physical-cognitive exercise at home for 60 minutes per day, 3 days per week, for 4 weeks. The usability of the game-based training system was evaluated using the system usability scale (SUS) after completion of a 4-week training program. As for satisfaction, the 8-item Physical Activity Enjoyment Scale (PACES) questionnaire was used to assess participants? enjoyment level after 1 week and 4 weeks of training. Descriptive statistics were used to illustrate the SUS score. A Wilcoxon signed-rank test was used to compare the PACES scores between the first week and the end of the 4-week period, with significance set at P<.05. Results: As for experts? consensus, the game-based training consisted of 3 games: Ocean Diver, Road Runner, and Moving and Memorizing. The games had 3 levels of difficulty: beginner, intermediate, and advanced. A computer vision?based system was selected as the delivery platform for a home setting. The total SUS score for all participants was mean 87.22 (SD 5.76), indicating the user?s perception of the usability of a system ranging from good to excellent. At the end of the 4-week training, the total PACES score was significantly greater than the first week, suggesting an improvement in enjoyment (first week: mean 44.93, SD 3.99 vs fourth week: mean 50.53, SD 4.70; P=.001). Conclusions: The prototype of low-intensity, gamification-based, interactive physical-cognitive training was designed and developed using the ADDIE model, which included both experts and end users in the process. The findings showed that the exergame prototype was a usable and practical approach for a home-based setting, enhancing older adults? enjoyment and motivation. Further research is warranted to determine the effectiveness of such gamification-based training in promoting physical and cognitive functions. UR - https://games.jmir.org/2024/1/e59141 UR - http://dx.doi.org/10.2196/59141 ID - info:doi/10.2196/59141 ER - TY - JOUR AU - Wan, Xiaonan AU - Lin, Zhengyu AU - Duan, Chengcheng AU - Zeng, Zhitong AU - Zhang, Chencheng AU - Li, Dianyou PY - 2024/10/23 TI - Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study JO - JMIR Aging SP - e57503 VL - 7 KW - remote programming KW - Parkinson disease KW - deep brain stimulation KW - telemedicine KW - economic evaluation N2 - Background: Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood. Objective: This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey. Methods: A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients? attitudes toward the 2 different programming methods. Results: A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources. Conclusions: Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions?burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients. UR - https://aging.jmir.org/2024/1/e57503 UR - http://dx.doi.org/10.2196/57503 ID - info:doi/10.2196/57503 ER - TY - JOUR AU - Flessa, J. Sarah AU - Harrison, D. James AU - Turnigan, Roniela AU - Rathfon, Megan AU - Chandler, Michael AU - Newton-Small, Jay AU - Rogers, E. Stephanie PY - 2024/9/27 TI - Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study JO - JMIR Aging SP - e59306 VL - 7 KW - co-design KW - storytelling KW - dementia KW - delirium KW - older adults KW - person-centered care N2 - 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. UR - https://aging.jmir.org/2024/1/e59306 UR - http://dx.doi.org/10.2196/59306 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59306 ER - TY - JOUR AU - Singh, Ankita AU - Chakraborty, Shayok AU - He, Zhe AU - Pang, Yuanying AU - Zhang, Shenghao AU - Subedi, Ronast AU - Lustria, Liza Mia AU - Charness, Neil AU - Boot, Walter PY - 2024/9/16 TI - Predicting Adherence to Computer-Based Cognitive Training Programs Among Older Adults: Study of Domain Adaptation and Deep Learning JO - JMIR Aging SP - e53793 VL - 7 KW - domain adaptation KW - adherence KW - cognitive training KW - deep neural networks KW - early detection of cognitive decline N2 - 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. UR - https://aging.jmir.org/2024/1/e53793 UR - http://dx.doi.org/10.2196/53793 ID - info:doi/10.2196/53793 ER - TY - JOUR AU - Kwan, Cho Rick Yiu AU - Liu, Justina AU - Sin, Kan Olive Suk AU - Fong, K. Kenneth N. AU - Qin, Jing AU - Wong, Yin Joe Chi AU - Lai, Claudia PY - 2024/9/11 TI - Effects of Virtual Reality Motor-Cognitive Training for Older People With Cognitive Frailty: Multicentered Randomized Controlled Trial JO - J Med Internet Res SP - e57809 VL - 26 KW - virtual reality KW - motor-cognitive training KW - cognitive frailty KW - gamification N2 - 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 UR - https://www.jmir.org/2024/1/e57809 UR - http://dx.doi.org/10.2196/57809 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57809 ER - TY - JOUR AU - Greene, Barry AU - Tobyne, Sean AU - Jannati, Ali AU - McManus, Killian AU - Gomes Osman, Joyce AU - Banks, Russell AU - Kher, Ranjit AU - Showalter, John AU - Bates, David AU - Pascual-Leone, Alvaro PY - 2024/8/19 TI - The Dual Task Ball Balancing Test and Its Association With Cognitive Function: Algorithm Development and Validation JO - J Med Internet Res SP - e49794 VL - 26 KW - cognitive function KW - dual task KW - inertial sensors KW - mHealth KW - tablet KW - MCI KW - Alzheimer KW - dementia KW - motor KW - older adults KW - cognitive impairment KW - balance? N2 - 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. UR - https://www.jmir.org/2024/1/e49794 UR - http://dx.doi.org/10.2196/49794 UR - http://www.ncbi.nlm.nih.gov/pubmed/39158963 ID - info:doi/10.2196/49794 ER - TY - JOUR AU - Jimenez, E. Daniel AU - Ross, J. Emily AU - Weinstein, Elliott AU - Gouse, Hetta AU - Pan, Yue AU - Martinez Garza, David AU - Burke, L. Shanna AU - Joo, Hui Jin AU - Behar-Zusman, Victoria PY - 2024/8/12 TI - Preventing Cognitive Decline in Older Latino Adults With HIV Through a Culturally Tailored Health Promotion Intervention: Protocol for a Single-Arm Pilot Trial JO - JMIR Res Protoc SP - e55507 VL - 13 KW - Latinos KW - HIV KW - AIDS KW - cognitive decline KW - health promotion KW - intervention KW - protocol KW - single-arm KW - pilot trial KW - prevention KW - older KW - cognitive impairment KW - impairment KW - treatment KW - dementia KW - psychosocial KW - men KW - women KW - cohort N2 - 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 UR - https://www.researchprotocols.org/2024/1/e55507 UR - http://dx.doi.org/10.2196/55507 UR - http://www.ncbi.nlm.nih.gov/pubmed/39133532 ID - info:doi/10.2196/55507 ER - TY - JOUR AU - Attarha, Mouna AU - de Figueiredo Pelegrino, Carolina Ana AU - Toussaint, Paule-Joanne AU - Grant, Sarah-Jane AU - Van Vleet, Thomas AU - de Villers-Sidani, Etienne PY - 2024/8/8 TI - Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e59705 VL - 13 KW - brain training KW - cognitive training KW - healthy aging KW - neuroplasticity KW - acetylcholine KW - FEOBV KW - randomized controlled trial KW - aging KW - ageing KW - elderly KW - elder KW - older adults KW - older adult KW - neurological health KW - cognitive KW - computerized brain training KW - computerize KW - cognition KW - cognitive decline KW - Canada N2 - 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 UR - https://www.researchprotocols.org/2024/1/e59705 UR - http://dx.doi.org/10.2196/59705 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59705 ER - TY - JOUR AU - Jeyasingh-Jacob, Julian AU - Crook-Rumsey, Mark AU - Shah, Harshvi AU - Joseph, Theresita AU - Abulikemu, Subati AU - Daniels, Sarah AU - Sharp, J. David AU - Haar, Shlomi PY - 2024/8/6 TI - Markerless Motion Capture to Quantify Functional Performance in Neurodegeneration: Systematic Review JO - JMIR Aging SP - e52582 VL - 7 KW - markerless motion capture KW - motion analysis KW - movement analysis KW - motion KW - neurodegeneration KW - neurodegenerative KW - systematic review KW - movement KW - body tracking KW - tracking KW - monitoring KW - clinical decision making KW - decision KW - decision making KW - dementia KW - neurodegenerative disease KW - mild cognitive impairment KW - Parkinson's disease KW - tool KW - mobility N2 - 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. UR - https://aging.jmir.org/2024/1/e52582 UR - http://dx.doi.org/10.2196/52582 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52582 ER - TY - JOUR AU - Zuo, Xinyi AU - Tang, Yong AU - Chen, Yifang AU - Zhou, Zhimiao PY - 2024/7/31 TI - 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 JO - JMIR Serious Games SP - e55785 VL - 12 KW - digital serious games KW - cognitive ability KW - daily behavioral capacity KW - mental health KW - depression KW - older adults with AD and MCI KW - AD KW - Alzheimer?s disease KW - MD KW - mild cognitive impairment KW - systematic review KW - meta-analysis N2 - 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 signi?cantly 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 UR - https://games.jmir.org/2024/1/e55785 UR - http://dx.doi.org/10.2196/55785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55785 ER - TY - JOUR AU - Tung, Heng-Hsin AU - Kuo, Chen-Yuan AU - Lee, Pei-Lin AU - Chang, Chih-Wen AU - Chou, Kun-Hsien AU - Lin, Ching-Po AU - Chen, Liang-Kung PY - 2024/7/30 TI - Efficacy of Digital Dance on Brain Imagery, Cognition, and Health: Randomized Controlled Trial JO - J Med Internet Res SP - e57694 VL - 26 KW - digital KW - somatosensory dance KW - somatosensory game KW - cognitive performance KW - physical function KW - resilience KW - demoralization KW - quality of life KW - dance KW - dancer KW - dancing KW - movement KW - sport KW - sports KW - cognitive KW - cognition KW - brain KW - neuroscience KW - image KW - imagery KW - imaging KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - somatosensory KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - game KW - games KW - gaming N2 - Background: Multidomain interventions have demonstrable benefits for promoting healthy aging, but self-empowerment strategies to sustain long-term gains remain elusive. Objective: This study evaluated the effects of digital somatosensory dance game participation on brain imagery changes as primary outcomes and other physical and mental health measures as secondary outcomes related to healthy aging. Methods: Between August 31, 2020, and June 27, 2021, this randomized controlled trial recruited 60 eligible participants older than 55 years with no recent engagement in digital dance games. A computer-generated randomization sequence was used to allocate participants 1:1, without stratification, to an intervention group (n=30) who underwent digital somatosensory dance game training or a control group (n=30). An anonymized code masked the intervention allocations from the investigators, and individuals who assigned the interventions were not involved in analyzing the study data. The intervention entailed two 30-minute dance game sessions per week for 6 months, and the control group received healthy aging education. Primary outcomes were brain imagery changes. All variables were measured at baseline and the 6-month follow-up, and intervention effects were estimated using t tests with intention-to-treat analyses. Results: Compared with the control group, intervention participants had significantly different brain imagery in the gray matter volume (GMV) of the left putamen (estimate 0.016, 95% CI 0.008 to 0.024; P<.001), GMV of the left pallidum (estimate 0.02, 95% CI 0.006 to 0.034; P=.004), and fractional amplitude of low frequency fluctuations of the left pallidum (estimate 0.262, 95% CI 0.084 to 0.439; P=.004). Additionally, the intervention group had different imagery in the cerebellum VI GMV (estimate 0.011, 95% CI 0.003 to 0.02; P=.01). The intervention group also had improved total Montreal Cognitive Assessment scores (estimate 1.2, 95% CI 0.27 to ?2.13; P<.01), quality of life (estimate 7.08, 95% CI 2.35 to 11.82; P=.004), and time spent sitting on weekdays (estimate ?1.96, 95% CI ?3.33 to ?0.60; P=.005). Furthermore, dance performance was significantly associated with cognitive performance (P=.003), health status (P=.14), resilience (P=.007), and demoralization (P<.001). Conclusions: Digital somatosensory dance game participation for 6 months was associated with brain imagery changes in multiple regions involving somatosensory, motor, visual, and attention functions, which were consistent with phenotypic improvements associated with healthy aging. Trial Registration: ClinicalTrials.gov NCT05411042; https://clinicaltrials.gov/study/NCT05411042 UR - https://www.jmir.org/2024/1/e57694 UR - http://dx.doi.org/10.2196/57694 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078687 ID - info:doi/10.2196/57694 ER - TY - JOUR AU - Zsoldos, Isabella AU - Trân, Eléonore AU - Fournier, Hippolyte AU - Tarpin-Bernard, Franck AU - Fruitet, Joan AU - Fouillen, Mélodie AU - Bailly, Gérard AU - Elisei, Frédéric AU - Bouchot, Béatrice AU - Constant, Patrick AU - Ringeval, Fabien AU - Koenig, Olivier AU - Chainay, Hanna PY - 2024/6/20 TI - The Value of a Virtual Assistant to Improve Engagement in Computerized Cognitive Training at Home: Exploratory Study JO - JMIR Rehabil Assist Technol SP - e48129 VL - 11 KW - cognitive training KW - cognitive decline KW - cognitive disorders KW - mild cognitive impairment KW - Alzheimer disease KW - digital therapies KW - virtual health assistant KW - conversational agent KW - artificial intelligence KW - social interaction KW - THERADIA N2 - 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. UR - https://rehab.jmir.org/2024/1/e48129 UR - http://dx.doi.org/10.2196/48129 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48129 ER - TY - JOUR AU - Fisher, Emily AU - Venkatesan, Shreenila AU - Benevides, Pedro AU - Bertrand, Elodie AU - Brum, Schimidt Paula AU - El Baou, Céline AU - Ferri, P. Cleusa AU - Fossey, Jane AU - Jelen, Maria AU - Laks, Jerson AU - Liu, Lisa AU - Mograbi, C. Daniel AU - Natarajan, Nirupama AU - Naylor, Renata AU - Pantouli, Despina AU - Ramanujam, Vaishnavi AU - Rangaswamy, Thara AU - Santos de Carvalho, L. Raquel AU - Stoner, Charlotte AU - Vaitheswaran, Sridhar AU - Spector, Aimee PY - 2024/6/11 TI - Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation JO - JMIR Aging SP - e55557 VL - 7 KW - psychosocial KW - intervention KW - technology KW - COVID-19 KW - LMIC KW - low and middle income countries N2 - Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. UR - https://aging.jmir.org/2024/1/e55557 UR - http://dx.doi.org/10.2196/55557 UR - http://www.ncbi.nlm.nih.gov/pubmed/38861708 ID - info:doi/10.2196/55557 ER - TY - JOUR AU - Szczepocka, Ewa AU - Mokros, ?ukasz AU - Kazmierski, Jakub AU - Nowakowska, Karina AU - ?ucka, Anna AU - Antoszczyk, Anna AU - Oltra-Cucarella, Javier AU - Werzowa, Walter AU - Hellevik, Moum Martin AU - Skouras, Stavros AU - Bagger, Karsten PY - 2024/6/5 TI - The Effectiveness of Virtual Reality?Based Training on Cognitive, Social, and Physical Functioning in High-Functioning Older Adults (CoSoPhy FX): 2-Arm, Parallel-Group Randomized Controlled Trial JO - JMIR Res Protoc SP - e53261 VL - 13 KW - cognitive functions KW - head-mounted-display KW - healthy seniors KW - virtual reality KW - well-being KW - mobile phone N2 - Background: Virtual reality (VR) has emerged as a promising technology for enhancing the health care of older individuals, particularly in the domains of cognition, physical activity, and social engagement. However, existing VR products and services have limited availability and affordability; hence, there is a need for a scientifically validated and personalized VR service to be used by older adults in their homes, which can improve their overall physical, cognitive, and social well-being. Objective: The main purpose of the CoSoPhy FX (Cognitive, Social, and Physical Effects) study was to analyze the effects of a VR-based digital therapeutics app on the cognitive, social, and physical performance abilities of healthy (high-functioning) older adults. This paper presents the study protocol and the results from the recruitment phase. Methods: A group of 188 healthy older adults aged 65-85 years, recruited at the Medical University of Lodz, Poland, were randomly allocated to the experimental group (VR dual-task training program) or to the control group (using a VR headset app showing nature videos). A total of 3 cognitive exercises were performed in various 360° nature environments delivered via a VR head-mounted display; the participants listened to their preferred music genre. Each patient received 3 sessions of 12 minutes per week for 12 weeks, totaling a minimum of 36 sessions per participant. Attention and working memory (Central Nervous System Vital Signs computerized cognitive battery) were used as primary outcomes, while other cognitive domains in the Central Nervous System Vital Signs battery, quality of life (World Health Organization?5 Well-Being Index), health-related quality of life (EQ-5D-5L), and anxiety (General Anxiety Disorder 7-item questionnaire) were the secondary outcomes. The group-by-time interaction was determined using linear mixed models with participants? individual slopes. Results: In total, 122 (39%) of the initial 310 participants failed to meet the inclusion criteria, resulting in a recruitment rate of 61% (188/310). Among the participants, 68 successfully completed the intervention and 62 completed the control treatment. The data are currently being analyzed, and we plan to publish the results by the end of September 2024. Conclusions: VR interventions have significant potential among healthy older individuals. VR can address various aspects of well-being by stimulating cognitive functions, promoting physical activity, and facilitating social interaction. However, challenges such as physical discomfort, technology acceptance, safety concerns, and cost must be considered when implementing them for older adults. Further research is needed to determine the long-term effects of VR-based interventions, optimal intervention designs, and the specific populations that would benefit most. Trial Registration: ClinicalTrials.gov NCT05369897; https://clinicaltrials.gov/study/NCT05369897 International Registered Report Identifier (IRRID): DERR1-10.2196/53261 UR - https://www.researchprotocols.org/2024/1/e53261 UR - http://dx.doi.org/10.2196/53261 UR - http://www.ncbi.nlm.nih.gov/pubmed/38837194 ID - info:doi/10.2196/53261 ER - TY - JOUR AU - Morita, Kentaro AU - Miura, Kenichiro AU - Toyomaki, Atsuhito AU - Makinodan, Manabu AU - Ohi, Kazutaka AU - Hashimoto, Naoki AU - Yasuda, Yuka AU - Mitsudo, Takako AU - Higuchi, Fumihiro AU - Numata, Shusuke AU - Yamada, Akiko AU - Aoki, Yohei AU - Honda, Hiromitsu AU - Mizui, Ryo AU - Honda, Masato AU - Fujikane, Daisuke AU - Matsumoto, Junya AU - Hasegawa, Naomi AU - Ito, Satsuki AU - Akiyama, Hisashi AU - Onitsuka, Toshiaki AU - Satomura, Yoshihiro AU - Kasai, Kiyoto AU - Hashimoto, Ryota PY - 2024/5/30 TI - Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study JO - JMIR Ment Health SP - e56668 VL - 11 KW - schizophrenia KW - cognitive function KW - eye movement KW - diagnostic biomarkers KW - digital health tools N2 - 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. UR - https://mental.jmir.org/2024/1/e56668 UR - http://dx.doi.org/10.2196/56668 UR - http://www.ncbi.nlm.nih.gov/pubmed/38815257 ID - info:doi/10.2196/56668 ER - TY - JOUR AU - Attarha, Mouna AU - Mahncke, Henry AU - Merzenich, Michael PY - 2024/5/13 TI - The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study JO - JMIR Form Res SP - e53623 VL - 8 KW - web-based cognitive assessment KW - remote data collection KW - neurocognition KW - cognitive profiles KW - normative assessment data KW - brain health KW - cognitive status KW - assessment accessibility N2 - Background: An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan. Objective: We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision. Methods: Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings. Results: Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors. Conclusions: The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization. UR - https://formative.jmir.org/2024/1/e53623 UR - http://dx.doi.org/10.2196/53623 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739916 ID - info:doi/10.2196/53623 ER - TY - JOUR AU - Tokunaga, Seiki AU - Sekiguchi, Takuya AU - Watanabe Miura, Kumi AU - Sugimoto, Hikaru AU - S Abe, Masato AU - Tamura, Kazuhiro AU - Kishimoto, Taishiro AU - Kudo, Takashi AU - Otake-Matsuura, Mihoko PY - 2024/4/22 TI - Home-Based Cognitive Intervention for Healthy Older Adults Through Asking Robots Questions: Randomized Controlled Trial JO - JMIR Aging SP - e47229 VL - 7 KW - cognitive intervention KW - home-based experiment KW - robots KW - older adults KW - technology adoption KW - digital health N2 - 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 UR - https://aging.jmir.org/2024/1/e47229 UR - http://dx.doi.org/10.2196/47229 ID - info:doi/10.2196/47229 ER - TY - JOUR AU - Ortega Morán, Francisco Juan AU - Pagador, Blas J. AU - Gilete Preciado, Vicente AU - Moyano-Cuevas, Luis José AU - Rodríguez Domínguez, Trinidad AU - Santurino Muñoz, Marta AU - Sánchez Margallo, M. Francisco PY - 2024/4/4 TI - A Serious Game for Cognitive Stimulation of Older People With Mild Cognitive Impairment: Design and Pilot Usability Study JO - JMIR Aging SP - e41437 VL - 7 KW - serious game KW - mild cognitive impairment KW - cognitive stimulation KW - design KW - pilot study KW - older people KW - activities of daily living KW - shopping KW - ecological validity N2 - Background: Cognitive stimulation of older people helps prevent, and even treat, age-related diseases, such as mild cognitive impairment. Playing games reduces the probability of experiencing this pathology, which is related to the loss of the ability to carry out some instrumental activities of daily living. Objective: This work describes the design and development of a serious game for the cognitive stimulation of older people, with exercises related to the daily life task of shopping. A pilot study for its preliminary usability validation is also presented. Methods: The designed serious game includes 4 exercises consisting of shopping in a hypermarket, ordering products, making payments, and organizing the purchase, thus dealing with the most frequent cognitive problems of older people associated with episodic declarative memory, naming, calculation, and organization, respectively. Results: A total of 19 older people participated in the pilot study for the usability validation of the serious game. They indicated that they like the aesthetic and interesting topic of the game. They reported that it provides a high level of entertainment and could be useful in daily life for mental stimulation. The participants found the serious game to be intuitive, but the ease of use and readability of the instructions could be improved. Conclusions: This study suggests that the innovative serious game developed could be accepted by older people for their cognitive stimulation to prevent or treat mild cognitive impairment, although a long-term intervention study should be performed as future work. Its ecological validity design, with everyday tasks, adaptable levels of difficulty, and motivational mechanisms, is a differentiating factor compared to similar serious games. UR - https://aging.jmir.org/2024/1/e41437 UR - http://dx.doi.org/10.2196/41437 ID - info:doi/10.2196/41437 ER - TY - JOUR AU - Mychajliw, Christian AU - Holz, Heiko AU - Minuth, Nathalie AU - Dawidowsky, Kristina AU - Eschweiler, Wilhelm Gerhard AU - Metzger, Gerhard Florian AU - Wortha, Franz PY - 2024/3/21 TI - 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 JO - JMIR Aging SP - e48265 VL - 7 KW - serial reaction time task KW - SRTT KW - implicit learning KW - mobile digital assessments KW - cognitive impairment KW - neurodegeneration KW - tablet-based testing KW - mild cognitive impairment KW - MCI KW - dementia KW - Alzheimer KW - neuropsychology KW - aging KW - older individuals N2 - 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 (?=?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. UR - https://aging.jmir.org/2024/1/e48265 UR - http://dx.doi.org/10.2196/48265 UR - http://www.ncbi.nlm.nih.gov/pubmed/38512340 ID - info:doi/10.2196/48265 ER - TY - JOUR AU - He, Qian AU - Wu, Hei Kevin Chun AU - Bennett, N. Adam AU - Zhang, Yue Jia AU - Chan, Katie Kei Hang PY - 2024/2/28 TI - 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 JO - JMIR Res Protoc SP - e47196 VL - 13 KW - network meta-analysis KW - cognitive impairment KW - Alzheimer disease KW - Alzheimer KW - neurodegenerative disorders KW - geriatric care KW - nutritional interventions KW - older patient KW - geriatric KW - cognitive decline KW - aging KW - older people KW - nutrition KW - cognitive KW - intervention KW - dementia KW - acute confusional senile dementia KW - Elder Nutritional Physiological Phenomena KW - Nutrition Physiology KW - meta-analysis KW - meta-analyses KW - systematic review KW - systematic reviews N2 - 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 UR - https://www.researchprotocols.org/2024/1/e47196 UR - http://dx.doi.org/10.2196/47196 UR - http://www.ncbi.nlm.nih.gov/pubmed/38416536 ID - info:doi/10.2196/47196 ER - TY - JOUR AU - Zhao, Sunyan AU - Zhang, Jing AU - Wan, Haijun AU - Tao, Chenjie AU - Hu, Meng AU - Liang, Wei AU - Xu, Zhi AU - Xu, Bingguo AU - Zhang, Jiaying AU - Wang, Guoxin AU - Li, Ping AU - Lyu, Guangmei AU - Gong, Yongling PY - 2024/2/8 TI - Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e53853 VL - 13 KW - older patients with cancer KW - cognitive impairment KW - chemobrain KW - Chinese medicine KW - electroacupuncture N2 - 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 UR - https://www.researchprotocols.org/2024/1/e53853 UR - http://dx.doi.org/10.2196/53853 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329790 ID - info:doi/10.2196/53853 ER - TY - JOUR AU - Urwyler, Prabitha AU - Gupta, Kumar Rajnish AU - Falkner, Michael AU - Niklaus, Joel AU - Müri, Martin René AU - Nef, Tobias PY - 2023/11/1 TI - Tablet-Based Puzzle Game Intervention for Cognitive Function and Well-Being in Healthy Adults: Pilot Feasibility Randomized Controlled Trial JO - JMIR Aging SP - e46177 VL - 6 KW - puzzle games KW - aging KW - cognitive assessment KW - visual attention KW - adults KW - elderly KW - well-being KW - randomized controlled trial KW - RCT KW - older adult N2 - Background: Promoting cognitive health is key to maintaining cognitive and everyday functions and preventing the risk of cognitive impairment or dementia. Existing scientific evidence shows the benefits of various training modalities on cognition. One way to promote cognitive health is through engagement in cognitive activities (eg, board and video games). Objective: This study aims to investigate the benefits of dynamic adaptive casual puzzle games on cognitive function and well-being in healthy adults and older people. Methods: A total of 12 adults and older people (female participants: n=6; mean age 58.92, SD 10.28 years; range 46-75 years) were included in this pilot randomized controlled trial. This study used a crossover design with two phases (8 weeks each) and three measurement waves (pretest, midtest, and posttest). The participants were randomly allocated either to the control or experimental group. In the control group, participants read newspapers between the pre- and midtest, then switched to cognitive training with puzzle games. In the experimental group, the interventions were reversed. Baseline measurements (pretest) were collected before the intervention. The interventions were delivered on tablet computers and took place unsupervised at participants? homes. Results: The outcome measures included global cognitive function, higher cognitive function, and emotional well-being at 3 time points (pretest, midtest, and posttest) using standardized neuropsychological tests. The participants showed improvements in their visual attention and visuospatial measures after the puzzle game intervention. Conclusions: The study showed that digital games are a feasible way to train cognition in healthy adults and older people. The algorithm-based dynamic adaption allows accommodations for persons with different cognitive levels of skill. The results of the study will guide future prevention efforts and trials in high-risk populations. Trial Registration: ClinicalTrials.gov NCT03139799; https://clinicaltrials.gov/study/NCT03139799 UR - https://aging.jmir.org/2023/1/e46177 UR - http://dx.doi.org/10.2196/46177 ID - info:doi/10.2196/46177 ER - TY - JOUR AU - Engineer, Margi AU - Kot, Sushant AU - Dixon, Emma PY - 2023/10/25 TI - Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis JO - JMIR Form Res SP - e48143 VL - 7 KW - natural language processing KW - consumer health information KW - readability KW - Alzheimer disease and related dementias KW - caregivers N2 - 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. UR - https://formative.jmir.org/2023/1/e48143 UR - http://dx.doi.org/10.2196/48143 UR - http://www.ncbi.nlm.nih.gov/pubmed/37878351 ID - info:doi/10.2196/48143 ER - TY - JOUR AU - Ramdeo, R. Karishma AU - Fahnestock, Margaret AU - Gibala, Martin AU - Selvaganapathy, Ravi Ponnambalam AU - Lee, Justin AU - Nelson, Jennifer Aimee PY - 2023/10/18 TI - The Effects of Exercise on Synaptic Plasticity in Individuals With Mild Cognitive Impairment: Protocol for a Pilot Intervention Study JO - JMIR Res Protoc SP - e50030 VL - 12 KW - mild cognitive impairment KW - exercise KW - brain-derived neurotrophic factor KW - cognition KW - brain plasticity KW - repetitive transcranial magnetic stimulation KW - transcranial magnetic stimulation KW - magnetic stimulation KW - aging KW - interval training KW - intermittent theta-burst stimulation KW - ageing KW - gerontology KW - geriatric KW - cognitive KW - physical activity KW - fitness KW - neurology KW - neuroscience KW - synapse KW - synaptic KW - plasticity KW - brain KW - neurotrophic KW - hormone KW - hormones KW - endocrinology N2 - 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 UR - https://www.researchprotocols.org/2023/1/e50030 UR - http://dx.doi.org/10.2196/50030 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851488 ID - info:doi/10.2196/50030 ER - TY - JOUR AU - Muurling, Marijn AU - Au-Yeung, M. Wan-Tai AU - Beattie, Zachary AU - Wu, Chao-Yi AU - Dodge, Hiroko AU - Rodrigues, K. Nathaniel AU - Gothard, Sarah AU - Silbert, C. Lisa AU - Barnes, L. Lisa AU - Steele, S. Joel AU - Kaye, Jeffrey PY - 2023/10/11 TI - 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 JO - JMIR Aging SP - e45876 VL - 6 KW - passive monitoring KW - in-home sensor KW - mild cognitive impairment KW - 2-person home KW - life space activity KW - sensor KW - older adult KW - aging KW - elder KW - gerontology KW - geriatric KW - cognition KW - cognitive impairment KW - activity pattern KW - at home KW - daily activities KW - activities of daily living KW - digital health KW - old age KW - technology N2 - 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. UR - https://aging.jmir.org/2023/1/e45876 UR - http://dx.doi.org/10.2196/45876 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819694 ID - info:doi/10.2196/45876 ER - TY - JOUR AU - Hamrick, Phillip AU - Sanborn, Victoria AU - Ostrand, Rachel AU - Gunstad, John PY - 2023/10/10 TI - Lexical Speech Features of Spontaneous Speech in Older Persons With and Without Cognitive Impairment: Reliability Analysis JO - JMIR Aging SP - e46483 VL - 6 KW - Alzheimer?s disease KW - cognitive dysfunction KW - early diagnosis KW - psychometrics KW - speech KW - technology assessment N2 - 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. UR - https://aging.jmir.org/2023/1/e46483 UR - http://dx.doi.org/10.2196/46483 ID - info:doi/10.2196/46483 ER - TY - JOUR AU - Lu, Zhipeng AU - Wang, Wenjin AU - Yan, Wei AU - Kew, Lin Chung AU - Seo, Hwaryoung Jinsil AU - Ory, Marcia PY - 2023/10/6 TI - The Application of Fully Immersive Virtual Reality on Reminiscence Interventions for Older Adults: Scoping Review JO - JMIR Serious Games SP - e45539 VL - 11 KW - older adults KW - fully immersive virtual reality KW - reminiscence KW - Alzheimer KW - cognitive function KW - mental health KW - psychological well-being KW - memory care KW - dementia KW - scoping review N2 - 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. UR - https://games.jmir.org/2023/1/e45539 UR - http://dx.doi.org/10.2196/45539 UR - http://www.ncbi.nlm.nih.gov/pubmed/37801360 ID - info:doi/10.2196/45539 ER - TY - JOUR AU - Krafft, Jelena AU - Barisch-Fritz, Bettina AU - Krell-Roesch, Janina AU - Trautwein, Sandra AU - Scharpf, Andrea AU - Woll, Alexander PY - 2023/8/22 TI - 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 JO - JMIR Aging SP - e46480 VL - 6 KW - dementia KW - individualized physical exercise KW - tailored exercise KW - physical activity KW - older adults KW - app KW - mobile health KW - mHealth KW - usability KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2023/1/e46480 UR - http://dx.doi.org/10.2196/46480 UR - http://www.ncbi.nlm.nih.gov/pubmed/37606974 ID - info:doi/10.2196/46480 ER - TY - JOUR AU - Choi, Ju-Young AU - Ha, Sang-Won AU - Jeong, Da-Eun AU - Lee, Jaeho AU - Kim, Donghoon AU - Min, Jin-Young AU - Min, Kyoung-Bok PY - 2023/7/10 TI - Association Between the Loss of Gait Harmony and Cognitive Impairment: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e46264 VL - 9 KW - cognitive function KW - gait phase KW - physical performance KW - dementia KW - older adult KW - aging KW - asymmetric KW - balance KW - gait analysis KW - cognition KW - cognitive impairment KW - gait KW - gait pattern N2 - 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 ? 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. UR - https://publichealth.jmir.org/2023/1/e46264 UR - http://dx.doi.org/10.2196/46264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428538 ID - info:doi/10.2196/46264 ER - TY - JOUR AU - Pike, Kerryn AU - Moller, I. Carl AU - Bryant, Christina AU - Farrow, Maree AU - Dao, P. Duy AU - Ellis, A. Kathryn PY - 2023/4/20 TI - 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 JO - J Med Internet Res SP - e41712 VL - 25 KW - cognition KW - learning KW - internet-based intervention KW - social support KW - subjective cognitive decline KW - mobile phone N2 - 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 UR - https://www.jmir.org/2023/1/e41712 UR - http://dx.doi.org/10.2196/41712 UR - http://www.ncbi.nlm.nih.gov/pubmed/37079356 ID - info:doi/10.2196/41712 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Abuelezz, Israa AU - AlSaad, Rawan AU - Al-Jafar, Eiman AU - Ahmed, Arfan AU - Aziz, Sarah AU - Nashwan, Abdulqadir AU - Sheikh, Javaid PY - 2023/4/12 TI - Serious Games for Learning Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e43607 VL - 25 KW - serious games KW - cognitive training KW - learning KW - exergames KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - systematic reviews KW - meta-analysis KW - mobile phone N2 - 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 UR - https://www.jmir.org/2023/1/e43607 UR - http://dx.doi.org/10.2196/43607 UR - http://www.ncbi.nlm.nih.gov/pubmed/37043277 ID - info:doi/10.2196/43607 ER - TY - JOUR AU - Manser, Patrick AU - Michels, Lars AU - Schmidt, André AU - Barinka, Filip AU - de Bruin, D. Eling PY - 2023/2/6 TI - 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 JO - JMIR Res Protoc SP - e41173 VL - 12 KW - cognition KW - cognitive impairment KW - effectiveness KW - exercise KW - exergame KW - neuroplasticity KW - neurosciences KW - technology KW - training N2 - 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 (?2p) 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 UR - https://www.researchprotocols.org/2023/1/e41173 UR - http://dx.doi.org/10.2196/41173 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745483 ID - info:doi/10.2196/41173 ER - TY - JOUR AU - Domingos, Josefa AU - Dean, John AU - Fernandes, Belo Júlio AU - Godinho, Catarina PY - 2022/12/22 TI - An Online Dual-Task Cognitive and Motor Exercise Program for Individuals With Parkinson Disease (PD3 Move Program): Acceptability Study JO - JMIR Aging SP - e40325 VL - 5 IS - 4 KW - Parkinson disease KW - dual-task training KW - exercise KW - digital intervention KW - online intervention KW - physical activity KW - physical therapy KW - elder KW - older adult KW - geriatric KW - neurodegenerative KW - adherence KW - acceptability KW - community based KW - group program KW - online program KW - physiotherapy KW - cognitive training online exercise KW - Parkinson's KW - neuromuscular KW - task training KW - physiotherapist KW - motor KW - movement KW - cognitive KW - cognition KW - vocal KW - voice KW - speech N2 - Background: Dual-task training is an emerging field used for people with Parkinson disease (PD) to improve their physical and cognitive well-being, but the patients? acceptability, safety, and adherence to such training in online settings are unknown. Objective: This study aims to evaluate the acceptability of a dual-task cognitive and motor online training program for people with PD as a group online community program. Methods: People with PD were invited to participate in an online program (PD3 Move) consisting of physical and vocal exercises in response to different cognitive challenges displayed as dynamic backgrounds on Zoom. The program ran twice per week for 16 weeks. Patient acceptability was assessed at 4 months by monitoring attendance rates and feedback from an exit questionnaire emailed to all participants assessing satisfaction, perceived benefit, safety, and willingness to continue and recommend to others. Results: The online program was delivered to 15 participants (n=9, 60%, females) with a diagnosis of PD, a mean age of 69.4 (SD 9.3) years, and Hoehn and Yahr (H&Y) stages I-IV. The attendance rate was high, with participants coming to more than 13 (81%) of the sessions. Participants were very satisfied (n=8, 53%) or satisfied (n=7, 47%) with the program. Participants reported that what they most liked were the new cognitive physical challenges. The 3 main facilitators to participating were perceiving the benefits, instructor?s flexibility and engagement, and the social interaction moments with others. The 3 main difficulties were dealing with motor fluctuations (n=3, 20%), difficulties in using technology (n=2, 13%), and difficulty hearing instructions due to hearing loss (n=2, 13%). Patients had favorable perceived benefits of the program, with 14 (93%) considering it very useful for the current management of health and 1 (7%) moderately useful. No adverse events were reported, and all participants said that they were willing to continue the program and recommend it to others. Conclusions: Our findings suggest that the online cognitive and motor program was well received, safe, and perceived to be of benefit to this group of medically stable people with PD in H&Y stages I-IV. Access to specialized care and enhancement of long-term adherence to regular exercise can be achieved with online community group programs. UR - https://aging.jmir.org/2022/4/e40325 UR - http://dx.doi.org/10.2196/40325 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548037 ID - info:doi/10.2196/40325 ER - TY - JOUR AU - Skirrow, Caroline AU - Meszaros, Marton AU - Meepegama, Udeepa AU - Lenain, Raphael AU - Papp, V. Kathryn AU - Weston, Jack AU - Fristed, Emil PY - 2022/9/30 TI - Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study JO - JMIR Aging SP - e37090 VL - 5 IS - 3 KW - neurology KW - memory KW - episodic KW - speech KW - psychometrics KW - reliability KW - validity KW - aging KW - elder KW - older adult KW - Alzheimer disease KW - mild cognitive impairment KW - mobile apps KW - mobile health KW - mHealth KW - smartphone KW - cognition KW - cognitive decline KW - cognitive impairment KW - development KW - validation KW - recall KW - story KW - stories KW - observational study KW - acceptability KW - usability KW - semantic KW - cognitive test KW - linguistic KW - mobile phone N2 - 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. UR - https://aging.jmir.org/2022/3/e37090 UR - http://dx.doi.org/10.2196/37090 UR - http://www.ncbi.nlm.nih.gov/pubmed/36178715 ID - info:doi/10.2196/37090 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Ahmed, Arfan AU - Alali, Haitham AU - Aldardour, Mohammad Ahmad AU - Househ, Mowafa PY - 2022/9/9 TI - The Effectiveness of Serious Games on Cognitive Processing Speed Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e36754 VL - 10 IS - 3 KW - serious games KW - cognitive training KW - exergames KW - processing speed KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - systematic reviews KW - meta-analysis KW - mobile phone N2 - 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 UR - https://games.jmir.org/2022/3/e36754 UR - http://dx.doi.org/10.2196/36754 UR - http://www.ncbi.nlm.nih.gov/pubmed/36083623 ID - info:doi/10.2196/36754 ER - TY - JOUR AU - Hackett, Katherine AU - Giovannetti, Tania PY - 2022/9/7 TI - Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools JO - JMIR Aging SP - e38130 VL - 5 IS - 3 KW - digital phenotyping KW - neuropsychology KW - aging KW - dementia KW - smartphone KW - neurological KW - psychological KW - older adults UR - https://aging.jmir.org/2022/3/e38130 UR - http://dx.doi.org/10.2196/38130 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069747 ID - info:doi/10.2196/38130 ER - TY - JOUR AU - Nitsan, Gal AU - Baharav, Shai AU - Tal-Shir, Dalith AU - Shakuf, Vered AU - Ben-David, M. Boaz PY - 2022/7/28 TI - Speech Processing as a Far-Transfer Gauge of Serious Games for Cognitive Training in Aging: Randomized Controlled Trial of Web-Based Effectivate Training JO - JMIR Serious Games SP - e32297 VL - 10 IS - 3 KW - aging KW - cognitive aging KW - cognitive games KW - serious games KW - speech processing KW - spoken language processing KW - eye tracking KW - visual world paradigm N2 - Background: The number of serious games for cognitive training in aging (SGCTAs) is proliferating in the market and attempting to combat one of the most feared aspects of aging?cognitive decline. However, the efficacy of many SGCTAs is still questionable. Even the measures used to validate SGCTAs are up for debate, with most studies using cognitive measures that gauge improvement in trained tasks, also known as near transfer. This study takes a different approach, testing the efficacy of the SGCTA?Effectivate?in generating tangible far-transfer improvements in a nontrained task?the Eye tracking of Word Identification in Noise Under Memory Increased Load (E-WINDMIL)?which tests speech processing in adverse conditions. Objective: This study aimed to validate the use of a real-time measure of speech processing as a gauge of the far-transfer efficacy of an SGCTA designed to train executive functions. Methods: In a randomized controlled trial that included 40 participants, we tested 20 (50%) older adults before and after self-administering the SGCTA Effectivate training and compared their performance with that of the control group of 20 (50%) older adults. The E-WINDMIL eye-tracking task was administered to all participants by blinded experimenters in 2 sessions separated by 2 to 8 weeks. Results: Specifically, we tested the change between sessions in the efficiency of segregating the spoken target word from its sound-sharing alternative, as the word unfolds in time. We found that training with the SGCTA Effectivate improved both early and late speech processing in adverse conditions, with higher discrimination scores in the training group than in the control group (early processing: F1,38=7.371; P=.01; ?p2=0.162 and late processing: F1,38=9.003; P=.005; ?p2=0.192). Conclusions: This study found the E-WINDMIL measure of speech processing to be a valid gauge for the far-transfer effects of executive function training. As the SGCTA Effectivate does not train any auditory task or language processing, our results provide preliminary support for the ability of Effectivate to create a generalized cognitive improvement. Given the crucial role of speech processing in healthy and successful aging, we encourage researchers and developers to use speech processing measures, the E-WINDMIL in particular, to gauge the efficacy of SGCTAs. We advocate for increased industry-wide adoption of far-transfer metrics to gauge SGCTAs. UR - https://games.jmir.org/2022/3/e32297 UR - http://dx.doi.org/10.2196/32297 UR - http://www.ncbi.nlm.nih.gov/pubmed/35900825 ID - info:doi/10.2196/32297 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Alhuwail, Dari AU - Ahmed, Arfan AU - Househ, Mowafa PY - 2022/7/25 TI - Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e36123 VL - 10 IS - 3 KW - serious games KW - cognitive training KW - exergames KW - executive functions KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - systematic reviews KW - meta-analysis N2 - 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 UR - https://games.jmir.org/2022/3/e36123 UR - http://dx.doi.org/10.2196/36123 UR - http://www.ncbi.nlm.nih.gov/pubmed/35877166 ID - info:doi/10.2196/36123 ER - TY - JOUR AU - Yaddaden, Amel AU - Spalla, Guillaume AU - Gouin-Vallerand, Charles AU - Briskie-Semeniuk, Patricia AU - Bier, Nathalie PY - 2022/7/20 TI - A Mixed Reality Cognitive Orthosis to Support Older Adults in Achieving Their Daily Living Activities: Focus Group Study With Clinical Experts JO - JMIR Rehabil Assist Technol SP - e34983 VL - 9 IS - 3 KW - cognitive orthosis KW - mixed reality KW - older adults KW - daily activities KW - qualitative study KW - focus group KW - mobile phone KW - smartphone N2 - Background: Mixed reality is an emerging technology that allows us to blend virtual objects into the actual user?s environment. This can be realized using head-mounted displays. Many recent studies have suggested the possibility of using this technology to support cognition in people with neurodegenerative disorders (NDs). However, most studies have explored improvements in cognition rather than in independence and safety during the accomplishment of daily living activities. Therefore, it is crucial to document the possibility of using mixed reality to support the independence of older adults in their daily lives. Objective: This study is part of a larger user-centered study of a cognitive orthosis using pure mixed reality to support the independence of people living with NDs. This study aimed to explore (the difficulties encountered by older adults with NDs in their daily life to ensure that pure mixed reality meets their needs, (the most effective interventions with this population to determine what types of assistance should be provided by pure mixed reality technology, how the pure mixed reality technology should provide assistance to promote aging in place, and the main facilitators of and barriers to the use of this technology. Methods: We conducted a descriptive, qualitative study. A total of 5 focus groups were completed with occupational therapists who had expertise in the disease and its functional impacts (N=29) to gather information. Each focus group met once for a 1-hour period. All sessions were held over a 3-month period. A semistructured interview guide was used. All group interviews were audiotaped with the consent of each participant to facilitate the data analysis. We conducted inductive qualitative analysis in four stages using a thematic analysis approach: full transcription of the audio recordings, first-order coding of the transcribed data, second-order coding from the first-order code list, and data reduction and matrix development. Results: The results suggested that the main difficulties encountered by this population were in remembering to complete tasks, initiating the tasks, and planning the tasks. Several interventions are used to improve the independence of this population, such as prevention, simplification or facilitation, adaptation, and compensation. The use of pure mixed reality in older adults with NDs to promote independence and safety at home is promising and may respond to several clinical functions identified by the participants. Finally, pure mixed reality has good potential for use in this population and involves certain facilitators and obstacles, such as resources, technical aspects, and social considerations. Conclusions: The cognitive orthosis that will be developed in light of this study will act as a proof of concept for the possibility of supporting people with NDs using pure mixed reality. UR - https://rehab.jmir.org/2022/3/e34983 UR - http://dx.doi.org/10.2196/34983 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857354 ID - info:doi/10.2196/34983 ER - TY - JOUR AU - Chang, Chien-Hsiang AU - Yeh, Chung-Hsing AU - Chang, Chien-Cheng AU - Lin, Yang-Cheng PY - 2022/7/14 TI - Interactive Somatosensory Games in Rehabilitation Training for Older Adults With Mild Cognitive Impairment: Usability Study JO - JMIR Serious Games SP - e38465 VL - 10 IS - 3 KW - dementia KW - elderly KW - usability KW - gesture recognition KW - card recognition rehabilitation KW - interactive somatosensory game N2 - 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. UR - https://games.jmir.org/2022/3/e38465 UR - http://dx.doi.org/10.2196/38465 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834303 ID - info:doi/10.2196/38465 ER - TY - JOUR AU - Harrington, Kyle AU - Craven, P. Michael AU - Wilson, L. Max AU - Landowska, Aleksandra PY - 2022/6/20 TI - Perceptions of Cognitive Training Games and Assessment Technologies for Dementia: Acceptability Study With Patient and Public Involvement Workshops JO - JMIR Serious Games SP - e32489 VL - 10 IS - 2 KW - dementia KW - cognitive assessment KW - cognitive training KW - serious games KW - patient and public involvement N2 - 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 ? 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 ? coefficients were observed between several coding themes between categories, including a relatively strong positive ? 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 UR - https://games.jmir.org/2022/2/e32489 UR - http://dx.doi.org/10.2196/32489 UR - http://www.ncbi.nlm.nih.gov/pubmed/35723912 ID - info:doi/10.2196/32489 ER - TY - JOUR AU - Ho, Ying Ka AU - Cheung, Mang Po AU - Cheng, Wing Tap AU - Suen, Yin Wing AU - Ho, Ying Hiu AU - Cheung, Ki Daphne Sze PY - 2022/5/11 TI - Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review JO - JMIR Aging SP - e35224 VL - 5 IS - 2 KW - virtual reality KW - apathy KW - cognitive impairment KW - dementia KW - systematic review N2 - 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 UR - https://aging.jmir.org/2022/2/e35224 UR - http://dx.doi.org/10.2196/35224 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544317 ID - info:doi/10.2196/35224 ER - TY - JOUR AU - Jacobson, Natasha AU - Lithgow, Brian AU - Jafari Jozani, Mohammad AU - Moussavi, Zahra PY - 2022/4/27 TI - 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 JO - JMIR Res Protoc SP - e37282 VL - 11 IS - 4 KW - transcranial alternating current stimulation KW - Alzheimer disease KW - cognitive impairment KW - double blind KW - treatment KW - placebo-controlled KW - randomized KW - crossover KW - dementia KW - cognitive N2 - 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 UR - https://www.researchprotocols.org/2022/4/e37282 UR - http://dx.doi.org/10.2196/37282 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475789 ID - info:doi/10.2196/37282 ER - TY - JOUR AU - Yuan, Jing AU - Au, Rhoda AU - Karjadi, Cody AU - Ang, Fang Ting AU - Devine, Sherral AU - Auerbach, Sanford AU - DeCarli, Charles AU - Libon, J. David AU - Mez, Jesse AU - Lin, Honghuang PY - 2022/4/15 TI - Associations Between the Digital Clock Drawing Test and Brain Volume: Large Community-Based Prospective Cohort (Framingham Heart Study) JO - J Med Internet Res SP - e34513 VL - 24 IS - 4 KW - Clock Drawing Test KW - digital KW - neuropsychological test KW - cognitive KW - technology KW - Boston Process Approach KW - neurology KW - Framingham Heart Study KW - dementia KW - Alzheimer N2 - 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. UR - https://www.jmir.org/2022/4/e34513 UR - http://dx.doi.org/10.2196/34513 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436225 ID - info:doi/10.2196/34513 ER - TY - JOUR AU - Ye, Siao AU - Sun, Kevin AU - Huynh, Duong AU - Phi, Q. Huy AU - Ko, Brian AU - Huang, Bin AU - Hosseini Ghomi, Reza PY - 2022/4/15 TI - A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study JO - JMIR Aging SP - e36825 VL - 5 IS - 2 KW - cognitive test KW - mild cognitive impairment KW - dementia KW - cognitive decline KW - repeatable battery KW - discriminant analysis N2 - 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. UR - https://aging.jmir.org/2022/2/e36825 UR - http://dx.doi.org/10.2196/36825 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436212 ID - info:doi/10.2196/36825 ER - TY - JOUR AU - Kleschnitzki, Marina Jana AU - Beyer, Luzi AU - Beyer, Reinhard AU - Großmann, Inga PY - 2022/4/1 TI - The Effectiveness of a Serious Game (MemoreBox) for Cognitive Functioning Among Seniors in Care Facilities: Field Study JO - JMIR Serious Games SP - e33169 VL - 10 IS - 2 KW - serious game KW - cognitive function KW - mental health KW - seniors KW - care facilities KW - aging KW - cognitive impairments KW - health technology N2 - Background: Serious games have been found to have enhancing and preventative effects on cognitive abilities in healthy older adults. Yet, there are few results on the effects in older seniors with age-related low cognitive impairments. Their special needs were considered when designing and using innovate technology in the area of prevention, which is especially relevant owing to the continuously aging population. Objective: The objective of this study was to evaluate the impact of a serious game on the cognitive abilities of seniors in order to potentially implement innovative resource-oriented technological interventions that can help to meet future challenges. Methods: In this controlled trial, we tested the serious game MemoreBox, which features modules specifically designed for seniors in nursing homes. Over a period of 1 year, we tested the cognitive abilities of 1000 seniors at 4 time points using the Mini-Mental Status Test. Only half of the participating seniors engaged with the serious game. Results: The study included an intervention group (n=56) and a control group (did not play; n=55). Based on the in-game data collection, a second intervention group (n=38) was identified within the original intervention group, which exactly followed the planned protocol. There were no noteworthy differences between the demographic and main variables of the overall sample. The large reduction in the sample size was due to the effects of the COVID-19 pandemic (drop-out rate: 88.9%). The CI was set at 5%. Mixed analysis of variance (ANOVA) between the cognitive abilities of the intervention and control groups did not show a statistically significant difference between time and group (F2.710,295.379=1.942; P=.13; partial ?²=0.018). We noted approximately the same findings for mixed ANOVA between the cognitive abilities of the second intervention and control groups (F3,273=2.574; P=.054; partial ?²=0.028). However, we did observe clear tendencies and a statistically significant difference between the 2 groups after 9 months of the intervention (t88.1=?2.394; P=.02). Conclusions: The results of this study show similarities with the current research situation. Moreover, the data indicate that the intervention can have an effect on the cognitive abilities of seniors, provided that they regularly play the serious game of MemoreBox. The small sample size means that the tendency toward improvement cannot be proven as statistically significant. However, the tendency shown warrants further research. Establishing an effective prevention tool as part of standard care in nursing homes by means of an easy-to-use serious game would be a considerable contribution to the weakened health care system in Germany as it would offer a means of activating senior citizens in partially and fully inpatient care facilities. Trial Registration: German Clinical Trials Register DRKS00016633; https://tinyurl.com/2e4765nj UR - https://games.jmir.org/2022/2/e33169 UR - http://dx.doi.org/10.2196/33169 UR - http://www.ncbi.nlm.nih.gov/pubmed/35172959 ID - info:doi/10.2196/33169 ER - TY - JOUR AU - Abd-alrazaq, Alaa AU - Alajlani, Mohannad AU - Alhuwail, Dari AU - Toro, T. Carla AU - Giannicchi, Anna AU - Ahmed, Arfan AU - Makhlouf, Ahmed AU - Househ, Mowafa PY - 2022/3/10 TI - The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e34592 VL - 10 IS - 1 KW - serious games KW - cognitive training KW - exergames KW - mild cognitive impairment KW - Alzheimer disease KW - dementia KW - global cognition KW - systematic review KW - meta-analysis N2 - 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. UR - https://games.jmir.org/2022/1/e34592 UR - http://dx.doi.org/10.2196/34592 UR - http://www.ncbi.nlm.nih.gov/pubmed/35266877 ID - info:doi/10.2196/34592 ER - TY - JOUR AU - Ferrario, Andrea AU - Luo, Minxia AU - Polsinelli, J. Angelina AU - Moseley, A. Suzanne AU - Mehl, R. Matthias AU - Yordanova, Kristina AU - Martin, Mike AU - Demiray, Burcu PY - 2022/3/8 TI - Predicting Working Memory in Healthy Older Adults Using Real-Life Language and Social Context Information: A Machine Learning Approach JO - JMIR Aging SP - e28333 VL - 5 IS - 1 KW - cognitive aging KW - language complexity KW - social context KW - machine learning KW - natural language processing KW - Electronically Activated Recorder (EAR) KW - behavioral indicators N2 - 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. UR - https://aging.jmir.org/2022/1/e28333 UR - http://dx.doi.org/10.2196/28333 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258457 ID - info:doi/10.2196/28333 ER - TY - JOUR AU - Zhu, KaiYan AU - Zhang, QiongYao AU - He, BingWei AU - Huang, MeiZhen AU - Lin, Rong AU - Li, Hong PY - 2022/2/21 TI - 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 JO - JMIR Serious Games SP - e32117 VL - 10 IS - 1 KW - cognitive intervention KW - dementia KW - immersive virtual reality KW - mild cognitive impairment KW - cognitive impairment KW - virtual reality KW - VR KW - older patients KW - usability KW - memory KW - stress N2 - 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 UR - https://games.jmir.org/2022/1/e32117 UR - http://dx.doi.org/10.2196/32117 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188466 ID - info:doi/10.2196/32117 ER - TY - JOUR AU - Gray, Michelle AU - Madero, N. Erica AU - Gills, L. Joshua AU - Paulson, Sally AU - Jones, D. Megan AU - Campitelli, Anthony AU - Myers, Jennifer AU - Bott, T. Nicholas AU - Glenn, M. Jordan PY - 2022/2/4 TI - Intervention for a Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity Study: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e31841 VL - 11 IS - 2 KW - health coaching KW - Alzheimer risk KW - digital health KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2022/2/e31841 UR - http://dx.doi.org/10.2196/31841 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119374 ID - info:doi/10.2196/31841 ER - TY - JOUR AU - Eastman, A. Jennifer AU - Kaup, R. Allison AU - Bahorik, L. Amber AU - Butcher, Xochitl AU - Attarha, Mouna AU - Marcus, M. Gregory AU - Pletcher, J. Mark AU - Olgin, E. Jeffrey AU - Barnes, E. Deborah AU - Yaffe, Kristine PY - 2022/2/2 TI - Remote Assessment of Cardiovascular Risk Factors and Cognition in Middle-Aged and Older Adults: Proof-of-Concept Study JO - JMIR Form Res SP - e30410 VL - 6 IS - 2 KW - mHealth KW - internet KW - mobile health KW - digital health KW - eHealth KW - cardiovascular KW - risk factors KW - cognition KW - cognitive impairment KW - remote cognitive assessment KW - aging N2 - 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 (?=-.51, 95% CI -0.91 to -0.11) and worse episodic memory (?=-.31, 95% CI -0.59 to -0.04); hypertension was associated with worse episodic memory (?=-.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. UR - https://formative.jmir.org/2022/2/e30410 UR - http://dx.doi.org/10.2196/30410 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107430 ID - info:doi/10.2196/30410 ER - TY - JOUR AU - Yu, Xinyue AU - Mu, Aruhan AU - Wu, Xiang AU - Zhou, Liqin PY - 2022/1/24 TI - Impact of Internet Use on Cognitive Decline in Middle-Aged and Older Adults in China: Longitudinal Observational Study JO - J Med Internet Res SP - e25760 VL - 24 IS - 1 KW - internet use KW - cognitive decline KW - China KW - fixed-effects analysis N2 - 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 (?=0.620, 95% CI 0.061 to 1.180; P=.04), work (?=0.896, 95% CI 0.271 to 1.520; P=.01), and entertainment (?=0.385, 95% CI ?0.008 to 0.778; P=.06), as well as less than once a week for social purposes (?=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 (?=?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 (?=0.458, 95% CI 0.065 to 0.850; P=.03) and at least once a week (?=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. UR - https://www.jmir.org/2022/1/e25760 UR - http://dx.doi.org/10.2196/25760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072642 ID - info:doi/10.2196/25760 ER - TY - JOUR AU - Lee, Jaegyeong AU - Lim, Min Jung PY - 2022/1/14 TI - Factors Associated With the Experience of Cognitive Training Apps for the Prevention of Dementia: Cross-sectional Study Using an Extended Health Belief Model JO - J Med Internet Res SP - e31664 VL - 24 IS - 1 KW - cognitive training apps KW - dementia knowledge KW - health belief model KW - middle-aged KW - logistic regression analysis KW - dementia KW - Alzheimer disease KW - cognition KW - mobile apps KW - health apps N2 - 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. UR - https://www.jmir.org/2022/1/e31664 UR - http://dx.doi.org/10.2196/31664 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029540 ID - info:doi/10.2196/31664 ER - TY - JOUR AU - Yang, Chao AU - Han, Xiaolei AU - Jin, Mingxue AU - Xu, Jianhui AU - Wang, Yiren AU - Zhang, Yajun AU - Xu, Chonglong AU - Zhang, Yingshi AU - Jin, Enshi AU - Piao, Chengzhe PY - 2021/12/30 TI - The Effect of Video Game?Based Interventions on Performance and Cognitive Function in Older Adults: Bayesian Network Meta-analysis JO - JMIR Serious Games SP - e27058 VL - 9 IS - 4 KW - video game KW - performance KW - cognitive function KW - older KW - Bayesian network meta-analysis N2 - Background: The decline in performance of older people includes balance function, physical function, and fear of falling and depression. General cognitive function decline is described in terms of processing speed, working memory, attention, and executive functioning, and video game interventions may be effective. Objective: This study evaluates the effect of video game interventions on performance and cognitive function in older participants in terms of 6 indicators: balance function, executive function, general cognitive function, physical function, processing speed, and fear of falling and depression. Methods: Electronic databases were searched for studies from inception to June 30, 2020. Randomized controlled trials and case-controlled trials comparing video game interventions versus nonvideo game control in terms of performance and cognitive function outcomes were incorporated into a Bayesian network meta-analysis. All data were continuous variables. Results: In total, 47 studies (3244 participants) were included. In pairwise meta-analysis, compared with nonvideo game control, video game interventions improved processing speed, general cognitive function, and depression scores. In the Bayesian network meta-analysis, interventions with video games improved balance function time (standardized mean difference [SMD] ?3.34, 95% credible interval [CrI] ?5.54 to ?2.56), the cognitive function score (SMD 1.23, 95% CrI 0.82-1.86), processing speed time (SMD ?0.29, 95% CrI ?0.49 to ?0.08), and processing speed number (SMD 0.72, 95% CrI 0.36-1.09), similar to the pairwise meta-analysis. Interventions with video games with strong visual senses and good interactivity ranked first, and these might be more beneficial for the elderly. Conclusions: Our comprehensive Bayesian network meta-analysis provides evidence that video game interventions could be considered for the elderly for improving performance and cognitive function, especially general cognitive scores and processing speed. Games with better interactivity and visual stimulation have better curative effects. Based on the available evidence, we recommend video game interventions for the elderly. Trial Registration: PROSPERO CRD42020197158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197158 UR - https://games.jmir.org/2021/4/e27058 UR - http://dx.doi.org/10.2196/27058 UR - http://www.ncbi.nlm.nih.gov/pubmed/34967759 ID - info:doi/10.2196/27058 ER - TY - JOUR AU - Yan, Mingli AU - Yin, Huiru AU - Meng, Qiuyan AU - Wang, Shuo AU - Ding, Yiwen AU - Li, Guichen AU - Wang, Chunyan AU - Chen, Li PY - 2021/12/3 TI - A Virtual Supermarket Program for the Screening of Mild Cognitive Impairment in Older Adults: Diagnostic Accuracy Study JO - JMIR Serious Games SP - e30919 VL - 9 IS - 4 KW - virtual reality KW - mild cognitive impairment KW - dementia KW - ambient intelligence KW - digital health KW - elderly population KW - aging N2 - 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 UR - https://games.jmir.org/2021/4/e30919 UR - http://dx.doi.org/10.2196/30919 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870610 ID - info:doi/10.2196/30919 ER - TY - JOUR AU - Cabral, F. Danylo AU - Hinchman, A. Carrie AU - Nunez, Christina AU - Rice, Jordyn AU - Loewenstein, A. David AU - Cahalin, P. Lawrence AU - Rundek, Tatjana AU - Pascual-Leone, Alvaro AU - Gomes-Osman, Joyce PY - 2021/11/23 TI - Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study JO - JMIR Res Protoc SP - e33589 VL - 10 IS - 11 KW - exercise KW - neuroplasticity KW - cognition KW - brain health KW - cardiorespiratory fitness KW - cardiovascular function KW - trophic factors KW - telehealth KW - aging adult N2 - 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 UR - https://www.researchprotocols.org/2021/11/e33589 UR - http://dx.doi.org/10.2196/33589 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817393 ID - info:doi/10.2196/33589 ER - TY - JOUR AU - Kelleher, Jessica AU - Zola, Stuart AU - Cui, Xiangqin AU - Chen, Shiyu AU - Gerber, Caroline AU - Parker, Willis Monica AU - Davis, Crystal AU - Law, Sidney AU - Golden, Matthew AU - Vaughan, P. Camille PY - 2021/10/19 TI - Personalized Visual Mapping Assistive Technology to Improve Functional Ability in Persons With Dementia: Feasibility Cohort Study JO - JMIR Aging SP - e28165 VL - 4 IS - 4 KW - aging KW - ageing KW - impaired memory KW - assistive technology KW - assistive technologies KW - function KW - assistive devices KW - cognition KW - cognitive KW - activities of daily living KW - mobile technology KW - mobile technologies KW - dementia KW - Alzheimer N2 - 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. UR - https://aging.jmir.org/2021/4/e28165 UR - http://dx.doi.org/10.2196/28165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34269690 ID - info:doi/10.2196/28165 ER - TY - JOUR AU - Henrique, Bazzanello Patrícia Paula AU - Perez, Pelle Fabrízzio Martin AU - Becker, Cemin Osvaldo Henrique AU - Bellei, Andrei Ericles AU - Biduski, Daiana AU - Korb, Arthiese AU - Pochmann, Daniela AU - Dani, Caroline AU - Elsner, Rostirola Viviane AU - De Marchi, Bertoletti Ana Carolina PY - 2021/10/13 TI - Kinesiotherapy With Exergaming as a Potential Modulator of Epigenetic Marks and Clinical Functional Variables of Older Women: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e32729 VL - 10 IS - 10 KW - elderly women KW - exergame KW - epigenome KW - cognition KW - kinesiotherapy N2 - Background: Kinesiotherapy is an option to mitigate worsening neuropsychomotor function due to human aging. Moreover, exergames are beneficial for the practice of physical therapy by older patients. Physical exercise interventions are known to alter the epigenome, but little is known about their association with exergames. Objective: We aim to evaluate the effects of kinesiotherapy with exergaming on older women?s epigenetic marks and cognitive ability, as well as on their clinical functional variables. Our hypothesis states that this kind of therapy can elicit equal or even better outcomes than conventional therapy. Methods: We will develop a virtual clinic exergame with 8 types of kinesiotherapy exercises. Afterward, we will conduct a 1:1 randomized clinical trial to compare the practice of kinesiotherapy with exergames (intervention group) against conventional kinesiotherapy (control group). A total of 24 older women will be enrolled for 1-hour sessions performed twice a week, for 6 weeks, totaling 12 sessions. We will assess outcomes using epigenetic blood tests, the Montreal Cognitive Assessment test, the Timed Up and Go test, muscle strength grading in a hydraulic dynamometer, and the Game Experience Questionnaire at various stages. Results: The project was funded in October 2019. Game development took place in 2020. Patient recruitment and a clinical trial are planned for 2021. Conclusions: Research on this topic is likely to significantly expand the understanding of kinesiotherapy and the impact of exergames. To the best of our knowledge, this may be one of the first studies exploring epigenetic outcomes of exergaming interventions. Trial Registration: Brazilian Clinical Trials Registry/Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-9tdrmw; https://ensaiosclinicos.gov.br/rg/RBR-9tdrmw. International Registered Report Identifier (IRRID): DERR1-10.2196/32729 UR - https://www.researchprotocols.org/2021/10/e32729 UR - http://dx.doi.org/10.2196/32729 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643543 ID - info:doi/10.2196/32729 ER - TY - JOUR AU - Saredakis, Dimitrios AU - Keage, AD Hannah AU - Corlis, Megan AU - Ghezzi, S. Erica AU - Loffler, Helen AU - Loetscher, Tobias PY - 2021/9/20 TI - The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial JO - J Med Internet Res SP - e29210 VL - 23 IS - 9 KW - reminiscence KW - head-mounted display KW - apathy KW - cognitive aging KW - dementia KW - residential facilities KW - virtual reality N2 - 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 (?22=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 UR - https://www.jmir.org/2021/9/e29210 UR - http://dx.doi.org/10.2196/29210 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542418 ID - info:doi/10.2196/29210 ER - TY - JOUR AU - Kwan, Cho Rick Yiu AU - Liu, Wa Justina Yat AU - Fong, Kuen Kenneth Nai AU - Qin, Jing AU - Leung, Kwok-Yuen Philip AU - Sin, Kan Olive Suk AU - Hon, Yuen Pik AU - Suen, W. Lydia AU - Tse, Man-Kei AU - Lai, KY Claudia PY - 2021/8/6 TI - Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial JO - JMIR Serious Games SP - e28400 VL - 9 IS - 3 KW - virtual reality KW - motor-cognitive training KW - cognitive frailty KW - game KW - feasibility KW - VR KW - training KW - older adults KW - frail KW - pilot study KW - randomized controlled trial N2 - 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 UR - https://games.jmir.org/2021/3/e28400 UR - http://dx.doi.org/10.2196/28400 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383662 ID - info:doi/10.2196/28400 ER - TY - JOUR AU - O'Loughlin, Patricia AU - Pavithra, Pavithra AU - Regan, John AU - Bennett, Marc AU - Knight, Rachel AU - Lenaert, Bert AU - Marquez, Melissa AU - Taddeo, Michelle AU - Griffith, James AU - Shapiro, Rita AU - Farina, Francesca PY - 2021/7/30 TI - 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 JO - JMIR Res Protoc SP - e30514 VL - 10 IS - 7 KW - fear KW - memory loss KW - dementia KW - older adults KW - mindfulness KW - behavioral activation N2 - 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 UR - https://www.researchprotocols.org/2021/7/e30514 UR - http://dx.doi.org/10.2196/30514 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328428 ID - info:doi/10.2196/30514 ER - TY - JOUR AU - Israsena, Pasin AU - Jirayucharoensak, Suwicha AU - Hemrungrojn, Solaphat AU - Pan-Ngum, Setha PY - 2021/6/15 TI - Brain Exercising Games With Consumer-Grade Single-Channel Electroencephalogram Neurofeedback: Pre-Post Intervention Study JO - JMIR Serious Games SP - e26872 VL - 9 IS - 2 KW - neurofeedback KW - serious gaming KW - serious game KW - brain exercise KW - cognition training KW - EEG KW - aging KW - cognition KW - cognitive KW - brain game N2 - 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. UR - https://games.jmir.org/2021/2/e26872 UR - http://dx.doi.org/10.2196/26872 UR - http://www.ncbi.nlm.nih.gov/pubmed/34128816 ID - info:doi/10.2196/26872 ER - TY - JOUR AU - Yuan, Jing AU - Libon, J. David AU - Karjadi, Cody AU - Ang, A. Alvin F. AU - Devine, Sherral AU - Auerbach, H. Sanford AU - Au, Rhoda AU - Lin, Honghuang PY - 2021/6/8 TI - Association Between the Digital Clock Drawing Test and Neuropsychological Test Performance: Large Community-Based Prospective Cohort (Framingham Heart Study) JO - J Med Internet Res SP - e27407 VL - 23 IS - 6 KW - clock drawing test KW - neuropsychological test KW - cognition KW - technology KW - digital assessment KW - mild cognitive impairment KW - association KW - neurology KW - Framingham Heart Study N2 - 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. UR - https://www.jmir.org/2021/6/e27407 UR - http://dx.doi.org/10.2196/27407 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100766 ID - info:doi/10.2196/27407 ER - TY - JOUR AU - Khaleghi, Ali AU - Aghaei, Zahra AU - Mahdavi, Amin Mohammad PY - 2021/5/18 TI - A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study JO - JMIR Serious Games SP - e21900 VL - 9 IS - 2 KW - cognitive tasks KW - boredom KW - motivation KW - gamification KW - game elements KW - framework KW - process KW - gamification design KW - cognitive training KW - cognitive assessment N2 - 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. UR - https://games.jmir.org/2021/2/e21900 UR - http://dx.doi.org/10.2196/21900 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819164 ID - info:doi/10.2196/21900 ER - TY - JOUR AU - Kang, Myeong Jae AU - Kim, Nambeom AU - Lee, Young Sook AU - Woo, Kyun Soo AU - Park, Geumjin AU - Yeon, Kil Byeong AU - Park, Woon Jung AU - Youn, Jung-Hae AU - Ryu, Seung-Ho AU - Lee, Jun-Young AU - Cho, Seong-Jin PY - 2021/5/6 TI - Effect of Cognitive Training in Fully Immersive Virtual Reality on Visuospatial Function and Frontal-Occipital Functional Connectivity in Predementia: Randomized Controlled Trial JO - J Med Internet Res SP - e24526 VL - 23 IS - 5 KW - virtual reality KW - cognitive training KW - visuospatial function KW - fMRI KW - visual network KW - mild cognitive impairment N2 - 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 UR - https://www.jmir.org/2021/5/e24526 UR - http://dx.doi.org/10.2196/24526 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955835 ID - info:doi/10.2196/24526 ER - TY - JOUR AU - Yeo, Shi Pei AU - Nguyen, Ngoc Tu AU - Ng, Ern Mary Pei AU - Choo, Munn Robin Wai AU - Yap, Kiat Philip Lin AU - Ng, Pin Tze AU - Wee, Liang Shiou PY - 2021/4/27 TI - 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 JO - JMIR Form Res SP - e25462 VL - 5 IS - 4 KW - group-based computerized cognitive training KW - cognition KW - gait KW - community program implementation KW - healthy older adults KW - cognitive KW - community program KW - cognitive training KW - elderly KW - aging N2 - 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 UR - https://formative.jmir.org/2021/4/e25462 UR - http://dx.doi.org/10.2196/25462 UR - http://www.ncbi.nlm.nih.gov/pubmed/33904819 ID - info:doi/10.2196/25462 ER - TY - JOUR AU - Rai, Kaur Harleen AU - Schneider, Justine AU - Orrell, Martin PY - 2021/4/8 TI - An Individual Cognitive Stimulation Therapy App for People With Dementia and Their Carers: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e24628 VL - 10 IS - 4 KW - dementia KW - cognitive stimulation therapy KW - touchscreen technology KW - feasibility trial KW - quality of life KW - mHealth KW - apps N2 - 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 UR - https://www.researchprotocols.org/2021/4/e24628 UR - http://dx.doi.org/10.2196/24628 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830058 ID - info:doi/10.2196/24628 ER - TY - JOUR AU - Hassandra, Mary AU - Galanis, Evangelos AU - Hatzigeorgiadis, Antonis AU - Goudas, Marios AU - Mouzakidis, Christos AU - Karathanasi, Maria Eleni AU - Petridou, Niki AU - Tsolaki, Magda AU - Zikas, Paul AU - Evangelou, Giannis AU - Papagiannakis, George AU - Bellis, George AU - Kokkotis, Christos AU - Panagiotopoulos, Rafail Spyridon AU - Giakas, Giannis AU - Theodorakis, Yannis PY - 2021/3/24 TI - ? Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study JO - JMIR Serious Games SP - e24170 VL - 9 IS - 1 KW - virtual reality KW - elderly KW - mild cognitive impairment KW - combined physical and cognitive function KW - dual task N2 - 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 ef?cacy of VRADA as a tool to promote physical and cognitive health in patients with MCI. UR - https://games.jmir.org/2021/1/e24170 UR - http://dx.doi.org/10.2196/24170 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759797 ID - info:doi/10.2196/24170 ER - TY - JOUR AU - Krebs, Christine AU - Falkner, Michael AU - Niklaus, Joel AU - Persello, Luca AU - Klöppel, Stefan AU - Nef, Tobias AU - Urwyler, Prabitha PY - 2021/3/22 TI - Application of Eye Tracking in Puzzle Games for Adjunct Cognitive Markers: Pilot Observational Study in Older Adults JO - JMIR Serious Games SP - e24151 VL - 9 IS - 1 KW - eye tracking KW - puzzle games KW - aging KW - cognitive assessment KW - cognition, attention, executive functions, visual search, fixations N2 - Background: Recent studies suggest that computerized puzzle games are enjoyable, easy to play, and engage attentional, visuospatial, and executive functions. They may help mediate impairments seen in cognitive decline in addition to being an assessment tool. Eye tracking provides a quantitative and qualitative analysis of gaze, which is highly useful in understanding visual search behavior. Objective: The goal of the research was to test the feasibility of eye tracking during a puzzle game and develop adjunct markers for cognitive performance using eye-tracking metrics. Methods: A desktop version of the Match-3 puzzle game with 15 difficulty levels was developed using Unity 3D (Unity Technologies). The goal of the Match-3 puzzle was to find configurations (target patterns) that could be turned into a row of 3 identical game objects (tiles) by swapping 2 adjacent tiles. Difficulty levels were created by manipulating the puzzle board size (all combinations of width and height from 4 to 8) and the number of unique tiles on the puzzle board (from 4 to 8). Each level consisted of 4 boards (ie, target patterns to match) with one target pattern each. In this study, the desktop version was presented on a laptop computer setup with eye tracking. Healthy older subjects were recruited to play a full set of 15 puzzle levels. A paper-pencil?based assessment battery was administered prior to the Match-3 game. The gaze behavior of all participants was recorded during the game. Correlation analyses were performed on eye-tracking data correcting for age to examine if gaze behavior pertains to target patterns and distractor patterns and changes with puzzle board size (set size). Additionally, correlations between cognitive performance and eye movement metrics were calculated. Results: A total of 13 healthy older subjects (mean age 70.67 [SD 4.75] years; range 63 to 80 years) participated in this study. In total, 3 training and 12 test levels were played by the participants. Eye tracking recorded 672 fixations in total, 525 fixations on distractor patterns and 99 fixations on target patterns. Significant correlations were found between executive functions (Trail Making Test B) and number of fixations on distractor patterns (P=.01) and average fixations (P=.005). Conclusions: Overall, this study shows that eye tracking in puzzle games can act as a supplemental source of data for cognitive performance. The relationship between a paper-pencil test for executive functions and fixations confirms that both are related to the same cognitive processes. Therefore, eye movement metrics might be used as an adjunct marker for cognitive abilities like executive functions. However, further research is needed to evaluate the potential of the various eye movement metrics in combination with puzzle games as visual search and attentional marker. UR - https://games.jmir.org/2021/1/e24151 UR - http://dx.doi.org/10.2196/24151 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749607 ID - info:doi/10.2196/24151 ER - TY - JOUR AU - Wittich, Walter AU - Pichora-Fuller, Kathleen M. AU - Johnson, Aaron AU - Joubert, Sven AU - Kehayia, Eva AU - Bachir, Vanessa AU - Aubin, Gabrielle AU - Jaiswal, Atul AU - Phillips, Natalie PY - 2021/3/11 TI - Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study JO - JMIR Res Protoc SP - e19931 VL - 10 IS - 3 KW - low vision KW - rehabilitation KW - cognition KW - aging KW - dementia KW - reading N2 - 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 UR - https://www.researchprotocols.org/2021/3/e19931 UR - http://dx.doi.org/10.2196/19931 UR - http://www.ncbi.nlm.nih.gov/pubmed/33704074 ID - info:doi/10.2196/19931 ER - TY - JOUR AU - Kim, Jeongsim AU - Shin, EunJi AU - Han, KyungHwa AU - Park, Soowon AU - Youn, Hae Jung AU - Jin, Guixiang AU - Lee, Jun-Young PY - 2021/2/16 TI - Efficacy of Smart Speaker?Based Metamemory Training in Older Adults: Case-Control Cohort Study JO - J Med Internet Res SP - e20177 VL - 23 IS - 2 KW - smart speaker KW - cognitive training KW - cognitive decline N2 - 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. UR - http://www.jmir.org/2021/2/e20177/ UR - http://dx.doi.org/10.2196/20177 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591276 ID - info:doi/10.2196/20177 ER - TY - JOUR AU - Cyr, Andrée-Ann AU - Romero, Kristoffer AU - Galin-Corini, Laura PY - 2021/2/1 TI - Web-Based Cognitive Testing of Older Adults in Person Versus at Home: Within-Subjects Comparison Study JO - JMIR Aging SP - e23384 VL - 4 IS - 1 KW - web-based testing KW - aging KW - cognition KW - neuropsychology KW - mobile phone N2 - 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. UR - http://aging.jmir.org/2021/1/e23384/ UR - http://dx.doi.org/10.2196/23384 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522972 ID - info:doi/10.2196/23384 ER - TY - JOUR AU - Chen, Yen-Fu AU - Janicki, Sylvia PY - 2020/12/14 TI - A Cognitive-Based Board Game With Augmented Reality for Older Adults: Development and Usability Study JO - JMIR Serious Games SP - e22007 VL - 8 IS - 4 KW - cognitive-based KW - augmented reality KW - board game KW - older adults KW - cognitive health KW - serious game N2 - Background: Older adults in Taiwan are advised to adopt regular physical and social activities for the maintenance of their cognitive and physical health. Games offer a means of engaging older individuals in these activities. For this study, a collaborative cognitive-based board game, Nostalgic Seekers, was designed and developed with augmented reality technology to support cognitive engagement in older adults. Objective: A user study of the board game was conducted to understand how the game facilitates communication, problem solving, and emotional response in older players and whether augmented reality is a suitable technology in game design for these players. Methods: A total of 23 participants aged 50 to 59 years were recruited to play and evaluate the game. In each session, participants? interactions were observed and recorded, then analyzed through Bales? interaction process analysis. Following each session, participants were interviewed to provide feedback on their experience. Results: The quantitative analysis results showed that the participants engaged in task-oriented communication more frequently than social-emotional communication during the game. In particular, there was a high number of answers relative to questions. The analysis also showed a significant positive correlation between task-oriented acts and the game score. Qualitative analysis indicated that participants found the experience of playing the game enjoyable, nostalgic objects triggered positive emotional responses, and augmented reality technology was widely accepted by participants and provided effective engagement in the game. Conclusions: Nostalgic Seekers provided cognitive exercise and social engagement to players and demonstrated the positive potential of integrating augmented reality technology into cognitive-based games for older adults. Future game designs could explore strategies for regular and continuous engagement. UR - http://games.jmir.org/2020/4/e22007/ UR - http://dx.doi.org/10.2196/22007 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315015 ID - info:doi/10.2196/22007 ER - TY - JOUR AU - Frost, Emily AU - Porat, Talya AU - Malhotra, Paresh AU - Picinali, Lorenzo PY - 2020/9/30 TI - A Novel Auditory-Cognitive Training App for Delaying or Preventing the Onset of Dementia: Participatory Design With Stakeholders JO - JMIR Hum Factors SP - e19880 VL - 7 IS - 3 KW - cognitive decline KW - mobile phone KW - hearing loss N2 - 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. UR - http://humanfactors.jmir.org/2020/3/e19880/ UR - http://dx.doi.org/10.2196/19880 UR - http://www.ncbi.nlm.nih.gov/pubmed/32996884 ID - info:doi/10.2196/19880 ER - TY - JOUR AU - Campbell, M. Laura AU - Paolillo, W. Emily AU - Heaton, Anne AU - Tang, Bin AU - Depp, A. Colin AU - Granholm, Eric AU - Heaton, K. Robert AU - Swendsen, Joel AU - Moore, J. David AU - Moore, C. Raeanne PY - 2020/9/24 TI - Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study JO - JMIR Mhealth Uhealth SP - e19579 VL - 8 IS - 9 KW - ecological momentary assessment KW - daily functioning KW - telemedicine KW - digital health KW - neuropsychological test KW - cognition KW - HIV KW - aging KW - mobile phone N2 - 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 (?=?1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (?=.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 (?=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (?=?.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. UR - http://mhealth.jmir.org/2020/9/e19579/ UR - http://dx.doi.org/10.2196/19579 UR - http://www.ncbi.nlm.nih.gov/pubmed/32969829 ID - info:doi/10.2196/19579 ER - TY - JOUR AU - Shen, Xiao AU - Wang, Guanjin AU - Kwan, Yiu-Cho Rick AU - Choi, Kup-Sze PY - 2020/8/31 TI - Using Dual Neural Network Architecture to Detect the Risk of Dementia With Community Health Data: Algorithm Development and Validation Study JO - JMIR Med Inform SP - e19870 VL - 8 IS - 8 KW - cognitive screening KW - dementia risk KW - dual neural network KW - predictive models KW - primary care N2 - 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. UR - https://medinform.jmir.org/2020/8/e19870 UR - http://dx.doi.org/10.2196/19870 UR - http://www.ncbi.nlm.nih.gov/pubmed/32865498 ID - info:doi/10.2196/19870 ER - TY - JOUR AU - Weizenbaum, Emma AU - Torous, John AU - Fulford, Daniel PY - 2020/7/23 TI - Cognition in Context: Understanding the Everyday Predictors of Cognitive Performance in a New Era of Measurement JO - JMIR Mhealth Uhealth SP - e14328 VL - 8 IS - 7 KW - smartphone KW - mobile phone KW - neuropsychology KW - individualized medicine N2 - Background: Research suggests that variability in attention and working memory scores, as seen across time points, may be a sensitive indicator of impairment compared with a singular score at one point in time. Given that fluctuation in cognitive performance is a meaningful metric of real-world function and trajectory, it is valuable to understand the internal state-based and environmental factors that could be driving these fluctuations in performance. Objective: In this viewpoint, we argue for the use of repeated mobile assessment as a way to better understand how context shapes moment-to-moment cognitive performance. To elucidate potential factors that give rise to intraindividual variability, we highlight existing literature that has linked both internal and external modifying variables to a number of cognitive domains. We identify ways in which these variables could be measured using mobile assessment to capture them in ecologically meaningful settings (ie, in daily life). Finally, we describe a number of studies that have already begun to use mobile assessment to measure changes in real time cognitive performance in people?s daily environments and the ways in which this burgeoning methodology may continue to advance the field. Methods: This paper describes selected literature on contextual factors that examined how experimentally induced or self-reported contextual variables (ie, affect, motivation, time of day, environmental noise, physical activity, and social activity) related to tests of cognitive performance. We also selected papers that used mobile assessment of cognition; these papers were chosen for their use of high-frequency time-series measurement of cognition using a mobile device. Results: Upon review of the relevant literature, it is evident that contextual factors have the potential to meaningfully impact cognitive performance when measured in laboratory and daily life environments. Although this research has shed light on the question of what gives rise to real-life variability in cognitive function (eg, affect and activity), many of the studies were limited by traditional methods of data collection (eg, involving retrospective recall). Furthermore, cognition has often been measured in one domain or in one age group, which does not allow us to extrapolate results to other cognitive domains and across the life span. On the basis of the literature reviewed, mobile assessment of cognition shows high levels of feasibility and validity and could be a useful method for capturing individual cognitive variability in real-world contexts via passive and active measures. Conclusions: We propose that, through the use of mobile assessment, there is an opportunity to combine multiple sources of contextual and cognitive data. These data have the potential to provide individualized digital signatures that could improve diagnostic precision and lead to meaningful clinical outcomes in a wide range of psychiatric and neurological disorders. UR - https://mhealth.jmir.org/2020/7/e14328 UR - http://dx.doi.org/10.2196/14328 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706680 ID - info:doi/10.2196/14328 ER - TY - JOUR AU - Guisado-Fernandez, Estefania AU - Blake, Catherine AU - Mackey, Laura AU - Silva, Alexandra Paula AU - Power, Dermot AU - O'Shea, Diarmuid AU - Caulfield, Brian PY - 2020/7/23 TI - A Smart Health Platform for Measuring Health and Well-Being Improvement in People With Dementia and Their Informal Caregivers: Usability Study JO - JMIR Aging SP - e15600 VL - 3 IS - 2 KW - Connected Health KW - dementia KW - informal caregiver KW - home care KW - home monitoring N2 - 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 UR - http://aging.jmir.org/2020/2/e15600/ UR - http://dx.doi.org/10.2196/15600 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706650 ID - info:doi/10.2196/15600 ER - TY - JOUR AU - Saredakis, Dimitrios AU - Keage, AD Hannah AU - Corlis, Megan AU - Loetscher, Tobias PY - 2020/6/26 TI - Using Virtual Reality to Improve Apathy in Residential Aged Care: Mixed Methods Study JO - J Med Internet Res SP - e17632 VL - 22 IS - 6 KW - reminiscence KW - head-mounted display KW - apathy KW - cognitive aging KW - dementia KW - residential facilities KW - virtual reality N2 - 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. UR - http://www.jmir.org/2020/6/e17632/ UR - http://dx.doi.org/10.2196/17632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32469314 ID - info:doi/10.2196/17632 ER - TY - JOUR AU - Masurovsky, Alexander PY - 2020/6/26 TI - Controlling for Placebo Effects in Computerized Cognitive Training Studies With Healthy Older Adults From 2016-2018: Systematic Review JO - JMIR Serious Games SP - e14030 VL - 8 IS - 2 KW - computerized cognitive training KW - brain training KW - placebo KW - active control KW - elderly KW - older adults N2 - Background: Computerized cognitive training has been proposed as a potential solution to age-related cognitive decline. However, published findings from evaluation studies of cognitive training games, including metastudies and systematic reviews, provide evidence both for and against transferability from trained tasks to untrained cognitive ability. There continues to be no consensus on this issue from the scientific community. Some researchers have proposed that the number of results supporting the efficacy of cognitive training may be inflated due to placebo effects. It has been suggested that placebo effects need to be better controlled by using an active control and measuring participant expectations for improvement in outcome measures. Objective: This review examined placebo control methodology for recent evaluation studies of computerized cognitive training programs with older adult subjects, specifically looking for the use of an active control and measurement of expectations. Methods: Data were extracted from PubMed. Evaluation studies of computerized cognitive training with older adult subjects (age ?50 years) published between 2016 and 2018 were included. Methods sections of studies were searched for (1) control type (active or passive) and subtype (active: active-ingredient or similar-form; passive: no-contact or passive-task); (2) if expectations were measured, how were they measured, and whether they were used in analysis; and (3) whether researchers acknowledged a lack of active control and lack of expectation measurement as limitations (where appropriate). Results: Of the 19 eligible studies, 4 (21%) measured expectations, and 9 (47%) included an active control condition, all of which were of the similar-form type. The majority of the studies (10/19, 53%) used only a passive control. Of the 9 studies that found results supporting the efficacy of cognitive training, 5 were for far transfer effects. Regarding the limitations, due to practical considerations, the search was limited to one source (PubMed) and to search results only. The search terms may have been too restrictive. Recruitment methods were not analyzed, although this aspect of research may play a critical role in systematically forming groups with different expectations for improvement. The population was limited to healthy older adults, while evaluation studies include other populations and cognitive training types, which may exhibit better or worse placebo control than the studies examined in this review. Conclusions: Poor placebo control was present in 47% (9/19) of the reviewed studies; however, the studies still published results supporting the effectiveness of cognitive training programs. Of these positive results, 5 were for far transfer effects, which form the basis for broad claims by cognitive training game makers about the scientific validity of their product. For a minimum level of placebo control, future evaluation studies should use a similar-form active control and administer a questionnaire to participants at the end of the training period about their own perceptions of improvement. Researchers are encouraged to think of more methods for the valid measure of expectations at other time points in the training. UR - http://games.jmir.org/2020/2/e14030/ UR - http://dx.doi.org/10.2196/14030 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589159 ID - info:doi/10.2196/14030 ER - TY - JOUR AU - Bonnechère, Bruno AU - Bier, Jean-Christophe AU - Van Hove, Olivier AU - Sheldon, Sally AU - Samadoulougou, Sékou AU - Kirakoya-Samadoulougou, Fati AU - Klass, Malgorzata PY - 2020/6/12 TI - Age-Associated Capacity to Progress When Playing Cognitive Mobile Games: Ecological Retrospective Observational Study JO - JMIR Serious Games SP - e17121 VL - 8 IS - 2 KW - cognitive performance KW - brain training KW - cognitive monitoring KW - mobile games KW - aging KW - serious games N2 - Background: The decline of cognitive function is an important issue related to aging. Over the last few years, numerous mobile apps have been developed to challenge the brain with cognitive exercises; however, little is currently known about how age influences capacity for performance improvement when playing cognitive mobile games. Objective: The objective of this study was to analyze the score data of cognitive mobile games over a period of 100 gaming sessions to determine age-related learning ability for new cognitive tasks by measuring the level of score improvement achieved by participants of different ages. Methods: Scores from 9000 individuals of different ages for 7 cognitive mobile games over 100 gaming sessions were analyzed. Scores from the first session were compared between age groups using one-way analysis of variance. Mixed models were subsequently used to investigate the progression of scores over 100 sessions. Results: Statistically significant differences were found between age groups for the initial scores of 6 of the 7 games (linear trend, P<.001). Cognitive mobile game scores increased for all participants (P<.001) suggesting that all participants were able to improve their performance. The rate of improvement was, however, strongly influenced by the age of the participant with slower progression for older participants (P<.001). Conclusions: This study provides evidence to support two interesting insights?cognitive mobile game scores appear to be sensitive to the changes in cognitive ability that occur with advancing age; therefore, these games could be a convenient way to monitor cognitive function over long-term follow-up, and users who train with the cognitive mobile games improve regardless of age. UR - http://games.jmir.org/2020/2/e17121/ UR - http://dx.doi.org/10.2196/17121 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530432 ID - info:doi/10.2196/17121 ER - TY - JOUR AU - Guzman-Parra, Jose AU - Barnestein-Fonseca, Pilar AU - Guerrero-Pertiñez, Gloria AU - Anderberg, Peter AU - Jimenez-Fernandez, Luis AU - Valero-Moreno, Esperanza AU - Goodman-Casanova, Marian Jessica AU - Cuesta-Vargas, Antonio AU - Garolera, Maite AU - Quintana, Maria AU - García-Betances, I. Rebeca AU - Lemmens, Evi AU - Sanmartin Berglund, Johan AU - Mayoral-Cleries, Fermin PY - 2020/6/1 TI - 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 JO - J Med Internet Res SP - e17253 VL - 22 IS - 6 KW - aging KW - mild cognitive impairment KW - dementia eHealth KW - information and communication technology KW - technophilia N2 - 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 UR - https://www.jmir.org/2020/6/e17253 UR - http://dx.doi.org/10.2196/17253 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442136 ID - info:doi/10.2196/17253 ER - TY - JOUR AU - Tsolaki, C. Anthoula AU - Tsolaki, Magda AU - Pandria, Niki AU - Lazarou, Eftychia AU - Gkatzima, Olymbia AU - Zilidou, Vasiliki AU - Karagianni, Maria AU - Iakovidou-Kritsi, Zafiroula AU - Kimiskidis, K. Vasilios AU - Bamidis, D. Panagiotis PY - 2020/5/7 TI - Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study JO - J Med Internet Res SP - e14617 VL - 22 IS - 5 KW - mild cognitive impairment KW - APOE ?4 KW - computerized training KW - exergaming KW - Alzheimer disease N2 - Background: Apolipoprotein E (APOE) ?4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ?4 carriers have never been studied before. Objective: The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated. Methods: Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ?4 carriers and non?APOE ?4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging. Results: All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score?LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores?AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score?LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ?4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ?4+ cognitive AC training group. Conclusions: None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ?POE ?4+ subgroup. UR - https://www.jmir.org/2020/5/e14617 UR - http://dx.doi.org/10.2196/14617 UR - http://www.ncbi.nlm.nih.gov/pubmed/32379048 ID - info:doi/10.2196/14617 ER - TY - JOUR AU - Khalili-Mahani, Najmeh AU - Assadi, Atousa AU - Li, Kate AU - Mirgholami, Mahsa AU - Rivard, Marie-Eve AU - Benali, Habib AU - Sawchuk, Kim AU - De Schutter, Bob PY - 2020/3/26 TI - Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study JO - JMIR Ment Health SP - e12388 VL - 7 IS - 3 KW - silver gaming KW - serious games KW - stress KW - cognitive training KW - brain training games KW - exercise games KW - ICT N2 - Background: The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants? motivations to adopt these technologies. Objective: This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework. Methods: A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire. Results: Session×activity effects were significant on all ambulatory measures (?210>20; P<.001) other than cortisol (P=.37). Compared with S1 and S2, S3 was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S1, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S3. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (?21>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. Conclusions: Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed. UR - http://mental.jmir.org/2020/3/e12388/ UR - http://dx.doi.org/10.2196/12388 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213474 ID - info:doi/10.2196/12388 ER - TY - JOUR AU - Øksnebjerg, Laila AU - Woods, Bob AU - Ruth, Kathrine AU - Lauridsen, Annette AU - Kristiansen, Susanne AU - Holst, Dalsgaard Helle AU - Waldemar, Gunhild PY - 2020/1/17 TI - A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns JO - JMIR Mhealth Uhealth SP - e14694 VL - 8 IS - 1 KW - dementia KW - technology KW - information technology KW - self-help devices KW - app KW - self-management KW - rehabilitation KW - memory KW - caregivers N2 - Background: Assistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption. Objective: This study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention. Methods: The ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ?90 days. Results: Data from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters. Conclusions: For participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia. UR - https://mhealth.jmir.org/2020/1/e14694 UR - http://dx.doi.org/10.2196/14694 UR - http://www.ncbi.nlm.nih.gov/pubmed/31951217 ID - info:doi/10.2196/14694 ER - TY - JOUR AU - Chua, Loon Sean Ing AU - Tan, Chuan Ngiap AU - Wong, Teen Wei AU - Allen Jr, Carson John AU - Quah, Min Joanne Hui AU - Malhotra, Rahul AU - Østbye, Truls PY - 2019/08/01 TI - Virtual Reality for Screening of Cognitive Function in Older Persons: Comparative Study JO - J Med Internet Res SP - e14821 VL - 21 IS - 8 KW - virtual reality KW - feasibility studies KW - mental status and dementia tests KW - technology KW - video games KW - dementia KW - cognitive dysfunction N2 - Background: The prevalence of dementia, which presents as cognitive decline in one or more cognitive domains affecting function, is increasing worldwide. Traditional cognitive screening tools for dementia have their limitations, with emphasis on memory and, to a lesser extent, on the cognitive domain of executive function. The use of virtual reality (VR) in screening for cognitive function in older persons is promising, but evidence for its use is sparse. Objective: The primary aim was to examine the feasibility and acceptability of using VR to screen for cognitive impairment in older persons in a primary care setting. The secondary aim was to assess the module?s ability to discriminate between cognitively intact and cognitively impaired participants. Methods: A comparative study was conducted at a public primary care clinic in Singapore, where persons aged 65-85 years were recruited based on a cut-off score of 26 on the Montreal Cognitive Assessment (MoCA) scale. They participated in a VR module for assessment of their learning and memory, perceptual-motor function, and executive function. Each participant was evaluated by the total performance score (range: 0-700) upon completion of the study. A questionnaire was also administered to assess their perception of and attitude toward VR. Results: A total of 37 participants in Group 1 (cognitively intact; MoCA score?26) and 23 participants in Group 2 (cognitively impaired; MoCA score<26) were assessed. The mean time to completion of the study was 19.1 (SD 3.6) minutes in Group 1 and 20.4 (3.4) minutes in Group 2. Mean feedback scores ranged from 3.80 to 4.48 (max=5) in favor of VR. The total performance score in Group 1 (552.0, SD 57.2) was higher than that in Group 2 (476.1, SD 61.9; P<.001) and exhibited a moderate positive correlation with scores from other cognitive screening tools: Abbreviated Mental Test (0.312), Mini-Mental State Examination (0.373), and MoCA (0.427). A receiver operating characteristic curve analysis for the relationship between the total performance score and the presence of cognitive impairment showed an area under curve of 0.821 (95% CI 0.714-0.928). Conclusions: We demonstrated the feasibility of using a VR-based screening tool for cognitive function in older persons in primary care, who were largely in favor of this tool. UR - https://www.jmir.org/2019/8/e14821/ UR - http://dx.doi.org/10.2196/14821 UR - http://www.ncbi.nlm.nih.gov/pubmed/31373274 ID - info:doi/10.2196/14821 ER - TY - JOUR AU - Jin, Yinzi AU - Jing, Mingxia AU - Ma, Xiaochen PY - 2019/07/29 TI - Effects of Digital Device Ownership on Cognitive Decline in a Middle-Aged and Elderly Population: Longitudinal Observational Study JO - J Med Internet Res SP - e14210 VL - 21 IS - 7 KW - digital access KW - cognitive decline KW - China N2 - Background: Cognitive decline is a major risk factor for disability and death and may serve as a precursor of dementia. Digital devices can provide a platform of cognitively stimulating activities which might help to slow cognitive decline during the process of normal aging. Objective: This longitudinal study aimed to examine the independent protective factors of desktop and cellphone ownership against cognitive decline in mid-life and older adulthood and to examine the combined effect of desktop and cellphone ownership on the same outcome. Methods: Data was obtained from a China Health and Retirement Longitudinal Studies (CHARLS) cohort made up of 13,457 community-dwelling adults aged 45 years or above in 2011-2012. They were followed for 4 years, with baseline measurements taken as well as 2 two-year follow-up visits. Cognitive function was tested during the baseline test and follow-up visits. A global cognition z-score was calculated based on two domains: word recall and mental intactness. The key independent variables were defined as: whether one had desktops with internet connection at home and whether one had a cellphone. An additional categorical variable of three values was constructed as: 0 (no desktop or cellphone), 1 (desktop or cellphone alone), and 2 (desktop and cellphone both). Mixed-effects regression was adjusted for demographic and health behavior as well as health condition risk factors. Results: Adjusted for demographic and health behavior as well as health condition risk factors, desktop and cellphone ownership were independently associated with subsequent decreased cognitive decline over the four-year period. Participants without a desktop at home had an adjusted cognitive decline of ?0.16 standard deviations (95% CI ?0.18 to ?0.15), while participants with a desktop at home had an adjusted cognitive decline of ?0.10 standard deviations (95% CI ?0.14 to ?0.07; difference of ?0.06 standard deviations; P=.003). A similar pattern of significantly protective association of 0.06 standard deviations (95% CI 0.03-0.10; P<.001) between cellphone ownership and cognitive function was observed over the four-year period. Additionally, a larger longitudinal protective association on cognitive decline was observed among those with both of the digital devices, although the 95% CIs for the coefficients overlapped with those with a single digital device alone. Conclusions: Findings from this study underscored the importance of digital devices as platforms for cognitively stimulating activities to delay cognitive decline. Future studies focusing on use of digital devices are warranted to investigate their longitudinal protective factors against cognitive decline at mid- and later life. UR - http://www.jmir.org/2019/7/e14210/ UR - http://dx.doi.org/10.2196/14210 UR - http://www.ncbi.nlm.nih.gov/pubmed/31359864 ID - info:doi/10.2196/14210 ER - TY - JOUR AU - Martens, Kris AU - Takano, Keisuke AU - Barry, J. Tom AU - Goedleven, Jolien AU - Van den Meutter, Louise AU - Raes, Filip PY - 2019/05/14 TI - Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study JO - J Med Internet Res SP - e13333 VL - 21 IS - 5 KW - memory specificity training KW - autobiographical memory KW - cognitive aging KW - online KW - depression KW - memory KW - telemedicine KW - rumination, cognitive N2 - 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. UR - https://www.jmir.org/2019/5/e13333/ UR - http://dx.doi.org/10.2196/13333 UR - http://www.ncbi.nlm.nih.gov/pubmed/31094362 ID - info:doi/10.2196/13333 ER - TY - JOUR AU - Kumar, Shefali AU - Tran, LA Jennifer AU - Moseson, Heidi AU - Tai, Caroline AU - Glenn, M. Jordan AU - Madero, N. Erica AU - Krebs, Caitlyn AU - Bott, Nicholas AU - Juusola, L. Jessie PY - 2018/11/09 TI - The Impact of the Virtual Cognitive Health Program on the Cognition and Mental Health of Older Adults: Pre-Post 12-Month Pilot Study JO - JMIR Aging SP - e12031 VL - 1 IS - 2 KW - cognitive impairment KW - dementia KW - Alzheimer disease KW - mental health N2 - Background: Face-to-face multidomain lifestyle interventions have shown to be effective for improving or maintaining cognitive function in older adults at risk for dementia. Remotely delivered interventions could increase access to such solutions but first require evidence to support that these programs can successfully impact health outcomes. Objective: The objective of this study was to evaluate the impact of a remotely delivered multidomain lifestyle intervention, the virtual cognitive health (VC Health) program, on the cognitive function and mental health of older adults with subjective cognitive decline (SCD). Methods: A 52-week, prospective, single-arm, pre-post, remote nationwide clinical trial was conducted to measure the change in cognitive function, depression, and anxiety levels for older adults at risk of developing dementia who participated in the VC Health program. A Web-based study platform was used to screen, consent, and enroll participants across the United States. Participants completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test and Web-based assessments (which included the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-7] surveys) at baseline and weeks 12, 24, and 52; all data were collected remotely. Changes in RBANS, PHQ-9, and GAD-7 were assessed using 2-tailed paired t tests and nonparametric signed-rank tests. Results: Participants (N=82) were, on average, aged 64 years (range 60.0-74.9 years), 74% (61/82) female, 88% (72/82) white, and 67% (55/82) had a college degree or higher. At baseline, participants had a mean and median RBANS Total Index score of 95.9 (SD 11.1) and 95.5 (interquartile range, IQR=13). Participants experienced a mean and median increase of 5.8 (SD 7.4) and 6 (IQR=11) in RBANS Total Index score from baseline to week 52 (P<.001). Participants had a mean and median PHQ-9 score of 8.5 (SD 4.9) and 8 (IQR=6) at baseline and experienced a mean and median decrease of 3.8 (SD 4.1) and 4 (IQR=6) units in PHQ-9 score from baseline to week 52 (P<.001). At baseline, participants had a mean and median GAD-7 score of 6.2 (SD 4.5) and 5.5 (IQR=6) and experienced a mean and median decrease of 2.9 (SD 4.1) and 2 (IQR=5) units in GAD-7 score from baseline to week 52 (P<.001). Participants were engaged and very satisfied with various program components. Conclusions: In this study, older adults with SCD who were at risk for dementia experienced statistically significant improvements in their cognitive function, depression, and anxiety levels. These findings serve as initial evidence for the overall feasibility and effectiveness of the VC Health program to improve or maintain cognitive function in older adults who are experiencing SCD. Further research should be conducted to understand the degree to which the improvements are attributable to specific components of the intervention. Trial Registration: ClinicalTrials.gov NCT02969460; https://clinicaltrials.gov/ct2/show/NCT02969460 (Archived by WebCite at http://www.webcitation.org/73XOph9Qm) UR - http://aging.jmir.org/2018/2/e12031/ UR - http://dx.doi.org/10.2196/12031 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518248 ID - info:doi/10.2196/12031 ER - TY - JOUR AU - Martínez-Alcalá, I. Claudia AU - Rosales-Lagarde, Alejandra AU - Hernández-Alonso, Esmeralda AU - Melchor-Agustin, Roberto AU - Rodriguez-Torres, E. Erika AU - Itzá-Ortiz, A. Benjamín PY - 2018/08/21 TI - A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study JO - JMIR Res Protoc SP - e172 VL - 7 IS - 8 KW - mobile application KW - cognitive stimulation KW - cognitive impairment KW - older adults KW - neuropsychological evaluation. N2 - Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 UR - http://www.researchprotocols.org/2018/8/e172/ UR - http://dx.doi.org/10.2196/resprot.9603 UR - http://www.ncbi.nlm.nih.gov/pubmed/30131319 ID - info:doi/10.2196/resprot.9603 ER -