Media enhanced educational and training interventions for the elderly/MCI

Sofia Segkouli, IoannisPaliokas, DimitriosTzovaras, CharalamposKaragiannidis, Magda Tsolaki

Presenter:

Dr. Ioannis G. PALIOKASPostdoctoral Researcher

Centre for Research and Technology Hellas

Information Technologies Institute

Contents

• Intro and Objectives

• Non–pharmacological interventions

• Cognitive-training computerized interventions

• Tasks and interface design

• Pilot study protocol

• Experimental results

• Lessons Learned

• Conclusions and future plans

Intro and Objectives

• Early detection of MCI conditions

• Memory

• Perception

• Executive control

• Language processing

• Early interventions

• Pharmaceutical

• Non-pharmaceutical

Prim

ary

Pre

vention

Secondary

Pre

vention

Tre

atm

ent

Normal Aging(No Disease)

Pre-symptomatic AD(No Symptoms)

MCI(Mild Memory Loss)

AD(Impairment)

Non–Pharmacological Interventions

Good clinical practice requires the clinician first to try non-pharmacological interventions before considering pharmacological approaches (Douglas et al., 2004)

Validation therapy Complementary therapy Interpersonal therapy

Reminiscence therapy Aromatherapy Bright-light therapy

Alternative therapies Art therapy Multisensory approaches

Behavioural therapy Music therapy Brief psychotherapies

Reality orientation Activity therapy Cognitive–behavioural therapy

Cognitive Decline

Diagnosis

Prevention

Therapy

Skills Training

Cognitive-Training Computerized Interventions

• Our approach combines Cognitive–Behavioural Therapies (CBT) and Multisensory approaches using Information and Communication Technologies (ICT) in a game-like environment

Train

• Short-term memory• Selective attention• Linguistic processing

Objectives

• Prevention• Screening• Diagnosis

for

Existing Cognitive Training Environments

Computerized cognitive tests and training environments • Computer-based Diagnostics:

• CANS-MCI

• CANTAB

• CNS Vital Signs

• CogState

• CSI MCI Screen

• MicroCog

• Mindstreams

• Web platforms:

• Cogweb

• Brain on Track (Tedim, 2014, Ruano, 2016)

• Computerized self test (CST) (Dougherty, 2010)

Linguistic Tasks DesignName Description Type of assessment

Word OrderingSentence construction based on scrambled words. Users re-order words to make meaningful sentences.

Syntactic/Grammatical assessment

Select Improper Sentence

Written Text comprehension task in which test givers try to select and erase an inappropriate sentence.

Visuospatial skills/ attentional control

AnagramGiven a set of letters, users try to construct words, like the scramble game.

Semantic memory /executive function/

Fill The GapGiven a set of sentences with a missing word (blank) and a set of words, users try to make the matching: Fill the gaps with the given words without replacement.

Ability to comprehend figurative expressions of language

Reading Comprehension

A typical reading comprehension task to test for the ability to read text, process it and understand its meaning

Visuospatial skills/ attentional control

Dialog Comprehension

Matchmaking task in which test givers try to find the social context in which a dialogue between two people is taking place.

Visuospatial skills/ attentional control /semantic ability

Dialog ConstructionFilling sentences in a dialogue context. Test givers try to fill missing parts of a dialogue based on interlocutor‘s response.

Syntactic/Grammatical assessment /semantic ability

Sayings/Non-;itera; expressions

Metaphoric sentences comprehension. Users try to give an interpretation of the meaning of the sentence (saying)

Visuospatial skills/ attentional control

Werb FormsFilling in the proper grammatical type. Given a verb, test givers try to give the right grammatical type to fill the blank in a sentence.

Grammatical ability/Visuospatial skills/attentional control

Interface Design• Accessibility standards (WCAG 2.0 guidelines)

• Design-for-all principles (ETSI Guide Human Factors: Guidelines for ICT products and services, EN ISO 14915: Software ergonomics for multimedia user interfaces)

• ISO/IEC TR 29138: Information technology - Accessibility considerations for people with disabilities

Computerized Interventions: What Works Differently

• Clinicians have full control over the process even if they are not present (face-to-face interviews)

• Professional services of high quality can be delivered by distance (personalized)

• Accurate measures of performance (vs. paper-and-pencil)

• Different cognitive maps using multimedia /hypermedia and multimodality: mental representations which help individuals to acquire & decode information, store & recall from memory

• Hands-on results (Brum et al., 2009; Tsolaki et al., 2011)

• Comparisons between user groups & sessions (Zygouris & Tsolaki, 2014).

Pilot study protocol• 115 elderly people, aged 55 to 78 years old

(M=65.57, SD=5.89)

• Two weeks study (in Alzheimer’s Day Care Unit ‘Saint John’ located in Thessaloniki, Greece)

• Total seventeen (N = 17) linguistic exercises

• Long sessions (2 hours)

• Up to 10 persons/group

• Touch screen and

mouse availability

• Live demonstration

before actual testing

Experimental Results• Standard neuropsychological assessment (MMSE,

FAS, CDR, TMT-B, RAVLT, FUCAS, DRSSD, TEA, face-to-face meetings with clinicians):• 92 MCI positives

• 22 healthy controls

• Two performance metrics:• Success rate (correct answers to the total number of

questions)

• Time needed to complete each task in seconds

• Log file analysis• Personalized user monitoring

• Accuracy in measures

• Immediate results

Experimental Results

• Computerized language activities require more time to be completed for people with MCI than for healthy controls

• The results of the experiment indicated that media and interaction enriched language exercises have a remarkable diagnostic and skills-training value

• On the other hand, after only two weeks of using the educational platform, all groups of participants showed a remarkable learning effect

Lessons Learned• The systematic use of language and multimedia in

computerized interventions could provide: • an additional diagnostic value

• an important role in educating the elderly on the PC

• the management of MCI symptoms as actions aimed at delaying the onset of dementia

• Computerized interventions have a number of advantages over traditional paper-and-pencil tools:• time and cost savings

• accurate data recording for decision support

• ability to compare the performance of patients between different disease development stages

Limitations• Non-direct linking between the previous clinical praxis

with the computerized interfaces

• Lack of widely approved psychometric models (Schegel, 2007)

• Recruitment criteria for the participants (elderly with basic computer skills)

• Distant sessions cannot be used for valid user/patient monitoring (high screening value vs. low diagnostic value)

• Previous education may have an effect on the most difficult linguistic tasks

• There are no sufficient interface design guidelines for people with cognitive decline

Conclusions and Future Plans

• Eliminate the Learning Effect:• Randomization of tasks

• Circulation of questions

• Perform a Test-Retest reliability study:• On the same tasks

• Under the same conditions

• In short period of time (compared with the progress of the MCI symptoms)

• Conclude if the measurements can be said repeatable (variation smaller than a pre-determined acceptance criterion)

Bibliography

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Thank you for your time!