Tania Giovannetti - US grants

PROJECT SUMMARY/ABSTRACT Difficulty completing everyday tasks is a primary reason for the high cost of care, loss of caregiver paid hours, and general caregiver burden associated with dementia. Electronic reminder applications hold promise as a low-cost solution to improve daily functioning, promote aging in place, and reduce caregiver burden and cost of care, particularly as older adults become more computer literate. There are many electronic reminders available for healthy individuals, but few have been developed to target the specific cognitive difficulties that impede completion of everyday tasks in people with dementia (i.e., premature decay of task goals, decreased motivation to perform tasks, distractibility, semantic knowledge degradation, etc.). Furthermore, there is a dearth of feasibility research on the fundamental efficacy and usability of reminder applications for people with dementia. This R21 proposal addresses these gaps with a feasibility study of the SmartPrompt, an enhanced electronic reminder aid designed for people with dementia that is used with an inexpensive smartphone. A diverse sample of older adults with mild dementia (N = 40) and their caregivers (N =40) will be trained to use the SmartPrompt and then asked to use the application to perform a target task (hydration, meals, or medication) twice per day in their homes for one week. Aim 1 will test the hypothesis that the SmartPrompt is effective at promoting everyday task completion (i.e., efficacy) relative to a one- week control period without the SmartPrompt. Using an AB/BA crossover design, efficacy outcomes will be obtained during the SmartPrompt and Control Conditions and will include participant and caregiver reports of task completion, caregiver report of burden, and participant report of frustration Aim 2 will investigate whether the SmartPrompt will be perceived favorably by participants and caregivers and the extent to which technical support is needed for its use (i.e., usability). Usability measures will be obtained from caregivers (report of technical problems, questionnaire), participants (questionnaire), the study team (training time, technical support required), and the smartphone (i.e., measures of smartphone use, response times to prompts). A third exploratory aim is to examine participant and caregiver features that are associated with efficacy and usability outcomes, including participant cognitive profile, participant/caregiver demographics, computer proficiency and self-efficacy, desire to change, etc. Results will be used to inform 1) a working model of barriers and facilitators for the use and efficacy of prompting applications that may be tested in future studies and 2) SmartPrompt design modifications for a future Phase II clinical trial.

PROJECT SUMMARY/ABSTRACT The goal of this proposal is to develop an objective, standardized, and efficient alternative to current methods of functional assessment for older adults across the spectrum of cognitive aging, from preclinical to mild dementia. Mild functional difficulties are a strong predictor of future cognitive decline and may precede impairment on traditional cognitive tests. Functional ability level is a criterion that distinguishes MCI from mild dementia, and unlike scores on tests of cognitive abilities, functional status generally is not as strongly influenced by race/ethnicity and socioeconomic status (SES). Consequently, information on functional status is often useful for determining the validity of low cognitive test scores in non-majority elders or elders with low educational attainment. The current benchmark standard method of functional assessment is informant report, which is subjective in nature and requires a knowledgeable partner. Thus, informant reports may be biased by cultural beliefs, lack of objectivity (e.g., they are based on individuals' personal task demands and informants' attention to detail), and in some cases may be unavailable. Traditional performance-based assessments offer advantages over informant reports, but they are time consuming to administer and score. Aim 1 of this proposal will evaluate the validity and reliability of a novel, portable, non-immersive, virtual- reality paradigm, the Virtual Kitchen Challenge (VKC). The VKC requires participants to complete two everyday tasks in a virtual kitchen using a touch-screen interface to select objects and sequence steps. A detailed automated score report reflecting time to completion, task accomplishment and performance efficiency is generated immediately after task completion. 180 individuals aged 65 and older with a range of cognitive abilities (healthy n = 60, mild cognitive impairment, MCI n = 60, mild dementia n = 60) will be administered the VKC as well as traditional cognitive tests (yielding demographically adjusted scores) and validated performance-based tasks with real objects. Informants also will be asked to complete questionnaires of functional status. We predict that the automated VKC score output will yield valid, reliable, and detailed characterizations of everyday function for participants at all levels of cognitive ability. Aim 2 will test the hypothesis that because of its practical, ecologically valid nature and objectivity, performance-based assessment of functioning (i.e., VKC) will be less influenced by race/ethnicity, education, and socioeconomic status than standard measures of cognition and informant report of function. However, if our hypothesis is not supported, demographic adjustments for interpreting VKC scores will be identified and applied. This proposal will yield an efficient and sensitive measure of everyday function for diverse older adults that may be used clinically when informants are unavailable or potentially unreliable, and may be scalable for large longitudinal studies of cognitive aging and dementia.

PROJECT SUMMARY/ABSTRACT There are very few effective interventions that promote functional independence in people with Alzheimer's disease (AD) and related dementias. This R21 project is the first step in our laboratory's long-term goal of developing an effective, enjoyable, portable, and inexpensive non-immersive virtual reality (VR) training intervention for improving the performance of everyday tasks. Our VR training approach is built upon the results of past studies that show 1) when people with AD repeatedly practice daily tasks they subsequently perform them more completely and without error; and 2) healthy people are able to transfer skills learned in VR-contexts to tasks in the real world. This R21 study will obtain preliminary data to inform a future randomized clinical trial through three aims: Aim 1) To test the hypothesis that individuals with mild- moderate AD will show improved performance on an everyday task after repeatedly practicing the task in a non-immersive VR setting; Aim 2) To test the hypothesis that participants demonstrate greater benefit from VR training when VR (training) objects are perceptually identical to objects used later in real-life; and Aim 3) To explore associations between individual differences variables (e.g., cognitive abilities, demographics) and training effects. To test Aim 1, 40 participants with mild to moderate AD will be recruited to complete daily VR Training sessions for one week. VR Training will include repeated practice of a single, everyday task in a non- immersive VR-context (VR Breakfast or VR Lunch; counterbalanced across participants). The primary outcome measure is performance of the real-life version of the trained task, which will be collected before and at two time points after training, compared to performance of an untrained, control task of comparable difficulty, and scored from video by coders blinded to training task/condition. To evaluate Aim 2, participants will be randomly assigned to complete VR training with either VR objects that perceptually match the test objects (e.g., same color, shape, size; Matched Objects, n = 20) or VR objects that are not perceptually similar to the test objects (e.g., different color, shape, size; Different Objects, n = 20). To evaluate Aim 3, all participants and an informant will complete interviews and questionnaires and participants will complete tests of cognitive abilities. Associations between participant variables and VR Training results will be explored. If our hypothesis is supported and results show that training effects generalize from virtual to real tasks in our sample, then VR training of custom and individualized tasks will be investigated in a future randomized, controlled clinical trial for maintaining and improving functional abilities in people with mild to moderate AD.