New assistive technologies to shape dementia care in future, a review

Dementia is a neuro-degenerative disorder, which gradually give rise to partial or complete dependence of patient unto their care-givers. New assistive technologies (ATs) have been designed to help care for People with Dementia (PwD). This approach aims to be more affordable and widely available than human workers, achieving greater health equity and quality of life for all. A recently published article in the Asian Journal of Psychiatry, reviews 44 articles that focus on ATS.

Dementia is characterized by global cognitive dysfunction, which can cause difficulties in performing Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs), leaving PwD who do not have the proper support extremely vulnerable. Dementia care should include preventative methods, particularly during the stage of mild cognitive impairment (MCI).

In MCI there is a deterioration of cognitive functions, mostly episodic memory problems, that do not result in issues with ADLs and IADLs. Types of AT used are as follows:

(a) Positioning system- Global Positioning Systems (GPS) and sensor based systems, are able to monitor the location of a patient. It intends to allow patients to independently move around, while simultaneously ensuring their safety. It can also help to monitor activity patterns, such as increased frequency of bathroom visits. Ideally, this would reduce the need for physical restraints, segregation, residential care living, and locked living environments.

(b) Health monitoring system- It focuses more on physiological health data and aims to help guide management plans. GPS and other sensors like pedometer, gyroscopes, and barometers can determine the amount and type of physical activity a patient has been engaging in. One project combined physical activity data with sleep duration to determine total energy expenditure to help guide nutrition management.

(c) Multi sensor environment/ambient assisted living- These are specially designed homes that contain sensory stimulation devices using lights, music, aromas, and objects. This type of AT can monitor patient's routine daily activities using sensors and intervene if any abnormalities are found. For example, if a patient was detected to be moving more than normal in bed during sleeping hours a tablet would start playing personal music choices and displaying personalized photos until the person settled. After a set time period if the person did not settle a notification would be sent to a call centre that would then phone the patient and escalate as needed. It has been found to reduce psychotic behaviors, improving functional performance, increasing levels of communication and interpersonal interaction, and decreasing anxiety and depression

(d) Reminder devices- These are common and may include a calendar, clock, checklists, diary notes, contacts, and alarm for scheduled events that a caregiver or the patient themselves an keep up to date.

(e) Patient coaching system/ cognitive support- The coaching systems are designed to lead patients through daily tasks, physical exercise, and cognitive training programs. Cognitive training programs are designed to improve memory, functional capabilities, and general health through educational/cognitive training.

(f) Lay-caregiver coaching system- It is comprised 2 domains:

1. Information and educational material on dementia and caregiver self care.

2. Caregivers could input patient health and behavioral data into questionnaires that allow for assessment of the patient at home. A clinician or AI algorithm can provide management recommendations after receiving alerts of a completed assessment.Support systems were made available to laycaregivers.

(g) Facial recognition devices- Devices made to help patients recognize the people they interact with involve cameras, smart devices, and facial recognition software. Patients scan the faces of those they come into contact with and their smart devices will remind them of the person's name and their relationship with the patient. These devices can help improve independence and maintain important relationships for the patient.

The ability of computers to perform human cognitive functions such as learning and problem solving, and was a key component in many of the new ATs found in this review. As more data is gathered, the goal is for artificial intelligence (AI) systems is to be able to advance their perceptions of human emotions and aberrant behaviors.

Doing so would allow for the creation of health care algorithms that could help uncover new knowledge and management options for dementia and MCI.

Source: Asian Journal of Psychiatry: https://doi.org/10.1016/j.ajp.2022.103135