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BACKGROUND: A decline in the ability to perform daily intentions-known as prospective memory-is a key driver of everyday functional impairment in dementia. In the absence of effective pharmacological treatments, there is a need for developing, testing, and optimizing behavioral interventions that can bolster daily prospective memory functioning. We investigated the feasibility and efficacy of smartphone-based strategies for prospective memory in persons with cognitive impairment.
METHODS: Fifty-two older adults (74.79 ± 7.20 years) meeting diagnostic criteria for mild cognitive impairment or mild dementia were enrolled in a 4-week randomized controlled trial. Participants were trained to use a digital voice recorder app or a reminder app to off-load prospective memory intentions. Prospective memory was assessed using experimenter-assigned tasks (e.g., call the laboratory on assigned days), standardized questionnaires, and structured interviews. Secondary dependent measures included days of phone and app usage, acceptability ratings, quality of life, and independent activities of daily living.
RESULTS: Participant ratings indicated that the intervention was acceptable and feasible. Furthermore, after the four-week intervention, participants reported improvements in daily prospective memory functioning on standardized questionnaires (p < 0.001, ?p2 = 0.285) and the structured interview (p < 0.001, d = 1.75). Participants performed relatively well on experimenter-assigned prospective memory tasks (51.7% ± 27.8%), with performance levels favoring the reminder app in Week 1, but reversing to favor the digital recorder app in Week 4 (p = 0.010, ?p2 = 0.079). Correlational analyses indicated that greater usage of the digital recorder or reminder app was associated with better prospective memory performance and greater improvements in instrumental activities of daily living (completed by care partners), even when controlling for condition, age, baseline cognitive functioning, and baseline smartphone experience.
CONCLUSIONS: Older adults with cognitive disorders can learn smartphone-based memory strategies and doing so benefits prospective memory functioning and independence.
|Family Medicine (FM)/General Practice (GP)|
|General Internal Medicine-Primary Care(US)|
This interesting small (N = 52) randomized trial tests the use of smartphone technology on prospective memory functioning in older adults with MCI or mild dementia. Using this technology over 4 weeks seemed to benefit prospective memory function. However, it was a short trial with a small and homogeneous group of participants. It will be valuable to to see how assistive technology such as this can be incorporated into routine practice. Follow up research is needed.
Any "intervention" that does not cause brain swelling and cost US$56K a year is worth pursuing. It is good that older adults with MCI can learn to use a smartphone app. It is impressive that nobody dropped out of the trial. These authors have shown that there is improvement on the study measures. The next step will have to be be to see whether improvement extends outside the study measures, i.e. in the participants' real lives. The investigators were comparing two interventions and did not have a non-intervention control group. So we cannot know how much was the benefit due to the attention and stimulation that people get from participating in a study (placebo). We don't know to whom these results could be generalized. They were all volunteers referred from a variety of sources, carrying diagnoses of MCI or dementia made somewhere, regardless of the etiology. Since test scores had to be between -1 and -2 SD below the mean, they were all no worse than MCI (no dementia).
Patients with cognitive impairment will benefit from any relevant aid, such as described in this paper.