Maribel Pino

L’aide aux personnes souffrant de maladie d’Alzheimer et à leurs aidants par les gérontechnologies

The increasing number of people suffering from Alzheimers disease raises the question of their caring at home, especially when the disease causes disability and negative consequences in daily life such as isolation, falls, wandering, errors in drug taking. Furthermore, caregivers bear a substantial burden that can have adverse effects on their physical and mental health. New technologies of information could play an additional role as care providers without substituting family or professional caregivers help. A review of literature focused on the different technological solutions conceived for patients suffering from Alzheimers disease and their carers shows that these appliances could help to provide reminders in daily life (drugs, tasks and appointments, meals cooking), to activate residual cognitive resources by computerized cognitive stimulation intervention, to reduce stress, anxiety and depressive symptoms in patients by visual contact with families and professionals (webconference), to contribute to patients safety by detecting falls and wandering, and to help families in the caring of patients with computerized information and counselling interventions. We also discuss the current limitations for a widespread use of these technologies and outline future research avenues. True needs of end-users are still poorly known and should be more clearly defined. Simplicity of the use of these appliances should be further improved. Demonstration of medical and social benefits for elderly people should be carried out in randomized, controlled studies. Ethical reflexion should be developed in conjunction with the use of these gerontechnologies. Finally, the economical model which would enable the providing of these appliances to the largest number of patients and caregivers should be implemented. Although these gerontechnologies are promising, research is still needed to tailor them properly to the needs of end-users, assess their benefit in ecological context of people with Alzheimers disease in order to provide them with appropriate tools in daily life.

The perceptions of cognitively impaired patients and their caregivers of a home telecare system.

Assistive and telecare technologies have been developed to support older adults with cognitive impairments, as well as their caregivers, from their homes. The way potential users perceive telecare and smart home systems plays a key role in their acceptance of this new technology. We evaluate the acceptance of home telecare technologies among patients suffering from cognitive impairment and their caregivers. Prototypes of telecare devices were developed to demonstrate their features and capabilities and to train patients, families, and health care professionals in their use. We conducted semistructured interviews to elicit the perceptions of 30 patients with mild cognitive impairment, 32 patients with Alzheimer’s disease, and 30 caregivers, regarding the risks and advantages of home telecare and smart houses. Survey results reflected participants’ largely positive reactions to these technologies. Regarding home telecare, the cognitive stimulation program earned the highest proportion of positive responses, followed by the devices’ care of emergencies. The participants generally agreed that home telecare and smart houses could significantly improve their quality of life. However, some technical and ethical concerns, such as the way of provision, installation, and monitoring of the systems, were reported to be in need of addressing before implementation of this system.

Maintaining Cognitive Functioning in Healthy Seniors with a Technology-Based Foreign Language Program: A Pilot Feasibility Study

Researchers have hypothesized that learning a foreign language could be beneficial for seniors, as language learning requires the use of extensive neural networks. We developed and qualitatively evaluated an English training program for older French adults; our principal objective was to determine whether a program integrating technology is feasible for this population. We conducted a 4-month pilot study (16, 2-h sessions) with 14 French participants, (nine women, five men, average age 75). Questionnaires were administered pre- and post-intervention to measure cognitive level and subjective feelings of loneliness or social isolation; however, these scores did not improve significantly. Post-intervention, semi-directive interviews were carried out with participants, and a content/theme analysis was performed. Five main themes were identified from the interviews: Associations with school, attitudes toward English, motivation for learning English, attitudes toward the program’s organization, and social ties. The program was found to be feasible for this age group, yet perceived as quite difficult for participants who lacked experience with English. Nonetheless, most participants found the program to be stimulating and enjoyable. We discuss different suggestions for future programs and future directions for foreign-language learning as a therapeutic and cognitive intervention.

Improving well-being in patients with major neurodegenerative disorders: differential efficacy of brief social robot-based intervention for 3 neuropsychiatric profiles

Background Behavioral and psychological symptoms of dementia (BPSD) affect patients’ daily life and subjective well-being. International recommendations stress nonpharmacological interventions as first-line treatment. While newer psychosocial initiatives adapted to geriatric populations based on social robot therapy have emerged, to our knowledge, no studies on differential efficacy depending on BPSD profiles have been conducted yet. Objectives This pilot study examined the impact of short exposure to a social robot (Paro®) on the subjective emotional well-being of patients with major neurocognitive disorder as well as its impact on differential effects for 3 BPSD profiles. Methods Seventeen patients with major NCD with apathy (n=6), depression (n=7), and agitation (n=4) were recruited. The intervention was composed of four 15-minute individual sessions. Exposure occurred without the simultaneous presence of a health care provider. A pre–post assessment of emotional well-being was conducted with the International Positive and Negative Affect Schedule Short-Form, which measures positive and negative affectivity. Results Overall findings showed a significant increase of positive affectivity (p=0.02). Subgroup analysis demonstrated that agitated patients reduced negative affectivity significantly more than depressed patients (p=0.03). Results also confirmed users’ overall acceptability of the robot. Conclusion These findings support the usefulness of brief interactive sessions with the Paro robot for elderly patients with major NCD. These preliminary results encourage further research focused on brief interventions using social robotics, as well as on their specific benefits depending on the behavioral typology of patients with neurocognitive disorders.

Assistive technologies for older adults with Alzheimer's disease: the Lusage user-lab experience

Background: The goals of this study are to critically review and analyze currently employed road test designs from published research studies involving cognitively impaired older drivers in order to define potential improvements that would enhance reliability, accuracy and validity. Methods: A literature review is complemented by detailed analyses of selected road test studies fromBrown andWashington Universities. We examine 1) inter-rater reliability of driving instructors from different geographic regions, 2) weighting bias by driving instructors in forming global impressions, 3) weighting of individual road test items by the instructors in forming global impressions, and 4) comparisons of road test and naturalistic home driving components using factor analysis.Results: Driving performance scores for videotaped home driving epochs by two driving instructors were modestly correlated. Differences in global impressions were partially attributable to the items of driving ability that were emphasized. Road test scores were unidimensional and reflected by a major factor related to awareness of signage and traffic behavior, while naturalistic home driving reflected two factors related to lane keeping as well as traffic behavior. Conclusions: Despite differences in geography and local driving regulations and practices, we have demonstrated that road test courses and driving examination scales can be harmonized; however, refinement in this area is still needed. Further improvements could include development of nationwide standards for scoring methodology for driving examiners, as well as road courses that incorporate the special challenges to examining the older driver in a more naturalistic and valid way.

How older adults with Alzheimer's disease allocate gaze during visual search

Background: Individuals living with Alzheimer’s disease (AD) may encounter somedifficulties in getting oriented in a new place, following a route to a familiar place or locating an object in an environment. All these tasks involve attentional processes and cognitive treatment of visual information. Primarily they are associated with eye movements. In this study we explore eye movement control during the visual scanning of daily life scenes in patients with AD or Mild Cognitive Impairment (MCI). The aim of this study is to help understanding of visual exploration strategies used by each subject group. Methods: Four groups of subjects were studied: young normal adults (YN; n 1⁄4 40), middle-aged adults (MA; n 1⁄4 40), older adults (OA; n 1⁄430), and patients with AD (AD; n1⁄4 40). Each participant completed two test-sessions. In the first one they were assessed with a standard neuropsychological battery, including visual acuity and contrast sensitivity testing. In the second one they underwent a set of visual search tasks on a computer. An infrared non-intrusive eye-tracker was used to record eye movements. Evaluation criteria included: task accuracy, initial saccade latency, scanning time and scanpath patterns. Results: Preliminary results confirmed that there are differences in visual exploration strategies used by older adults with AD and MCI, and those employed by subjects in the two control groups (OA and YN). Participants in the AD andMCI groups would use less specific and less pragmatic exploration strategies, than those used the control groups. AD patients have longer reaction times and detect fewer targets than controls. Combined analysis of eye tracking and neuropsychological data shows that semantic memory and working memory play an important role in the tasks of visual attention. Comparison between age groups shows that information processing speed appears to be a very age-sensitive cognitive function. Conclusions: Non-invasive eye tracking technology provides a fresh insight into the difficulties related to attentional control encountered by older peoplewithAD in the achievement of daily tasks. Understanding visual attention deficits in AD and in MCI will be useful to enhance environmental design for these disorders, and to develop cognitive training programs focused on these processes.