Technology-enhanced multi-domain at home continuum of care program with respect to usual care for people with cognitive impairment: the Ability-TelerehABILITation study protocol for a randomized controlled trial

Abstract

BackgroundAccording to the World Alzheimer Report (Prince, The Global Impact of Dementia: an Analysis of Prevalence, Incidence, Cost and Trends, 2015), 46.8 million people worldwide are nowadays living with dementia. And this number is estimated to approximate 131.5 million by 2050, with an increasing burden on society and families. The lack of medical treatments able to stop or slow down the course of the disease has moved the focus of interest toward the nonpharmacological approach and psychosocial therapies for people with/at risk of dementia, as in the Mild Cognitive Impairment (MCI) condition. The purpose of the present study is to test an individualized home-based multidimensional program aimed at enhancing the continuum of care for MCI and outpatients with dementia in early stage using technology.MethodsThe proposed study is a single blind randomized controlled trial (RCT) involving 30 subjects with MCI and Alzheimer’s disease (AD) randomly assigned to the intervention group (Ability group), who will receive the “Ability Program”, or to the active control group (ACG), who will receive “Treatment As Usual” (TAU). The protocol provides for three steps of assessment: at the baseline (T_0), after treatment, (T_1) and at follow-up (T_2) with a multidimensional evaluation battery including cognitive functioning, behavioral, functional, and quality of life measures. The Ability Program lasts 6 weeks, comprises tablet-delivered cognitive (5 days/week) and physical activities (7 days/week) combined with a set of devices for the measurement and monitoring from remote of vital and physical health parameters. The TAU equally lasts 6 weeks and includes paper and pencil cognitive activities (5 days/week), with clinician’s prescription to perform physical exercise every day and to monitor selected vital parameters.DiscussionResults of this study will inform on the efficacy of a technology-enhanced home care service to preserve cognitive and motor levels of functioning in MCI and AD, in order to slow down their loss of autonomy in daily life. The expected outcome is to ensure the continuity of care from clinical practice to the patient’s home, enabling also cost effectiveness and the empowerment of patient and caregiver in the care process, positively impacting on their quality of life.Trial registrationClinicalTrials.gov ID: NCT02746484 (registration date: 12/apr/2016 – retrospectively registered).

Feasibility of a Functional Medicine Approach to Slowing Clinical Cognitive Decline in Patients over Age 55: A Multiple Case Study Report

“…Under the supervision of the psychologist on the research team, all patients received cliniciandelivered cognitive training using the Brain Booster [41] program by LearningRx. Although cognitive training programs vary in the skills targeted and delivery mechanism of training (for example, computer games that target memory and attention [42][43][44] versus comprehensive clinician-delivered cognitive training of multiple cognitive skills [45][46][47][48]), cognitive training is supported by a growing body of research suggesting it can improve brain plasticity, memory, quality of life, and outlook [45,[49][50][51]. Brain Booster targets multiple cognitive constructs including processing speed, attention, working memory, long-term memory, fluid reasoning, visual processing, and auditory processing.…”

The Policies of Provision of Assistive and Welfare Technology—A Literature Review

“…It is also clear that the deployment of technology in different cultural contexts is not an automatic process and will likely require other approaches, such as bringing the technology to where it is needed rather than bringing the person to the technology. There are ongoing research efforts and interests in the development of AT/WT devices in many areas, especially related to dementia [45][46][47], which is increasing among the older population, as well as in AT provision in low-income settings where the key component is civil society [39,40,48]. Regarding the developing countries, it is vital to build local skills and solutions for such contexts, and further research must be done.…”

Social Cognition in Rehabilitation Context: Different Evolution of Affective and Cognitive Theory of Mind in Mild Cognitive Impairment

“…To avoid learning effects, ToM tests were not administered at 6 months. Between the first and the second steps of evaluation, the aMCI participants underwent a 6-week MST@H following the "Multidimensional Stimulation Therapy" (MST) model proposed by Baglio et al [26] and adapted for MCI [28,29].…”

“…Between the T0 and the T1, all aMCI participants took part in MST@H ( Figure 1). Such intervention consists of 30 home-based rehabilitation sessions over 6 weeks according to the "Multidimensional Stimulation Therapy" (MST) model proposed by Baglio and colleagues [26] and adapted for people with MCI [28,29]. The training involves daily cognitive activities (5 days a week), light aerobic physical activities (7 days a week), and occupational/recreational activities aimed at promoting the patient-caregiver interaction at home (7 days a week).…”