Victoria Cristancho-Lacroix

The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot

The purpose of this study was to explore perceived difficulties and needs of older adults with mild cognitive impairment (MCI) and their attitudes toward an assistive robot to develop appropriate robot functionalities. Twenty subjects were recruited to participate in either a focus group or an interview. Findings revealed that although participants reported difficulties in managing some of their daily activities, they did not see themselves as needing assistance. Indeed, they considered that they were capable of coping with difficulties with some compensatory strategies. They therefore declared that they did not need or want a robot for the moment but that they considered it potentially useful either for themselves in the future or for other older adults suffering from frailty, loneliness, and disability. Factors underlying unwillingness to adopt an assistive robot were discussed. These issues should be carefully addressed in the design and diffusion processes of an assistive robot.

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.

A Web-Based Program for Informal Caregivers of Persons With Alzheimer’s Disease: An Iterative User-Centered Design

Background Web-based programs have been developed for informal caregivers of people with Alzheimer’s disease (PWAD). However, these programs can prove difficult to adopt, especially for older people, who are less familiar with the Internet than other populations. Despite the fundamental role of usability testing in promoting caregivers’ correct use and adoption of these programs, to our knowledge, this is the first study describing this process before evaluating a program for caregivers of PWAD in a randomized clinical trial. Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD, aiming to reduce caregivers’ stress, and based on the user-centered design approach. Methods There were 49 participants (12 health care professionals, 6 caregivers, and 31 healthy older adults) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability. This process included three component parts: (1) project team workshops, (2) a proof of concept, and (3) two usability tests. The usability tests were based on a mixed methodology using behavioral analysis, semistructured interviews, and a usability questionnaire. Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program, and to improve website usability. The professionals, caregivers (mainly spouses), and older adults considered that our project met the needs of isolated caregivers. Participants underlined that contact between caregivers would be desirable. During usability observations, the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces. Moreover, negative self-stereotyping was evidenced, when comparing interviews and results of behavioral analysis. Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs. Nevertheless, a user-centered design approach involving targeted users (or their representatives) remains crucial for their correct use and adoption. For future user-centered design studies, we recommend to involve end-users from preconception stages, using a mixed research method in usability evaluations, and implementing pilot studies to evaluate acceptability and feasibility of programs.

Age-Related Evolution Patterns in Online Handwriting

Characterizing age from handwriting (HW) has important applications, as it is key to distinguishing normal HW evolution with age from abnormal HW change, potentially triggered by neurodegenerative decline. We propose, in this work, an original approach for online HW style characterization based on a two-level clustering scheme. The first level generates writer-independent word clusters from raw spatial-dynamic HW information. At the second level, each writers words are converted into a Bag of Prototype Words that is augmented by an interword stability measure. This two-level HW style representation is input to an unsupervised learning technique, aiming at uncovering HW style categories and their correlation with age. To assess the effectiveness of our approach, we propose information theoretic measures to quantify the gain on age information from each clustering layer. We have carried out extensive experiments on a large public online HW database, augmented by HW samples acquired at Broca Hospital in Paris from people mostly between 60 and 85 years old. Unlike previous works claiming that there is only one pattern of HW change with age, our study reveals three major aging HW styles, one specific to aged people and the two others shared by other age groups.

From aging to early-stage Alzheimer's: Uncovering handwriting multimodal behaviors by semi-supervised learning and sequential representation learning

Abstract We present, in this paper, a novel paradigm for assessing Alzheimer’s disease and aging by analyzing impairment of handwriting (HW) on tablets, a challenging problem that is still in its infancy. The state of the art is dominated by methods that assume a unique behavioral trend for each cognitive profile or age group, and that extract global kinematic parameters, assessed by standard statistical tests or classification models, for discriminating the neuropathological disorders (Alzheimer’s (AD), Mild Cognitive Impairment (MCI)) from Healthy Controls (HC), or HC age groups from each other. Our work tackles these two major limitations as follows. First, instead of considering a unique behavioral pattern for each cognitive profile or age group, we relax this heavy constraint by allowing the emergence of multimodal behavioral patterns. We achieve this by performing semi or unsupervised learning to uncover homogeneous clusters of subjects, and then we analyze how much information these clusters carry on the cognitive profiles (or age groups). Second, instead of relying on global kinematic parameters, mostly consisting of their average, we refine the encoding either by a semi-global parameterization, or by modeling the full dynamics of each parameter, harnessing thereby the rich temporal information inherently characterizing online HW. To illustrate the power of our paradigm, we present three studies, one regarding age, and two regarding Alzheimer’s. Thanks to our modeling, we obtain new findings that are the first of their kind on this research field. On aging, unlike previous works reporting only one pattern of HW change with age, our study, based on a semiglobal parametrization scheme, uncovers three major aging HW styles, one specific to aged subjects and two shared with other age groups. On Alzheimer’s, a striking finding is revealed: two major clusters are unveiled, one dominated by HC and MCI subjects, and one by MCI and ES-AD, thus revealing that MCI patients have fine motor skills leaning towards either HC’s or ES-AD’s. Our paper introduces also a new temporal representation learning from HW trajectories that uncovers a rich set of features simultaneously like the full velocity profile, size and slant, fluidity, and shakiness, and reveals, in a naturally explainable way, how these HW features conjointly characterize, with fine and subtle details, the cognitive profiles.

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.

Computerized cognitive stimulation and engagement programs in older adults with mild cognitive impairment: comparing feasibility, acceptability, and cognitive and psychosocial effects

Purpose Mild cognitive impairment (MCI) is associated with a higher risk of dementia and is becoming a topic of interest for pharmacological and nonpharmacological interventions. With advances in technology, computer-based cognitive exercises are increasingly integrated into traditional cognitive interventions, such as cognitive training. Another type of cognitive intervention involving technology use is cognitive engagement, consisting of involving participants in highly motivational and mentally challenging activities, such as learning to use a form of new digital technology. This study examined the feasibility and acceptability of a computerized cognitive stimulation (CCS) program and a computerized cognitive engagement (CCE) program, and then compared their effects in older adults with MCI. Patients and methods In this randomized study, data from 19 MCI patients were analyzed (n=9 in CCS and n=10 in CCE). The patients attended a group weekly session for a duration of 3 months. Assessments of cognitive and psychosocial variables were conducted at baseline (M0) and at the end of the programs (M3). Results All of the participants attended the 12 sessions and showed a high level of motivation. Attrition rate was very low (one dropout at M3 assessment). At M3, the CCS participants displayed a significant improvement in part B of the Trail Making Test (TMT-B; p=0.03) and self-esteem (p=0.005), while the CCE participants showed a significant improvement in part A of the Trail Making Test (TMT-A; p=0.007) and a higher level of technology acceptance (p=0.006). The two groups did not differ significantly (p>0.05) in cognitive and psychosocial changes after the intervention. However, medium effect sizes (Cohen’s d=0.56; 95% CI =−0.43:1.55) were found on the free recall, favoring the CCS group, as well as on TMT-A (d=0.51; 95% CI =−0.48:1.49) and technology acceptance (d=−0.65; 95% CI =−1.64:0.34), favoring the CCE group. Conclusion Both interventions were highly feasible and acceptable and allowed improvement in different aspects of cognitive and psychosocial functioning in MCI subjects.

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.