[Living Lab and technologies for the elderly]. / Living lab et technologies pour les personnes âgées.

The living lab is an approach that encourages the design and development of innovative technological solutions in a process of coconstruction involving users and other key players. Its methodology develops the technologies of the Broca living lab, dedicated to the care of elderly people with cognitive disorders and their carers.

SMR/Theta Neurofeedback Training Improves Cognitive Performance and EEG Activity in Elderly With Mild Cognitive Impairment: A Pilot Study.

Background: Neurofeedback (NF) training, as a method of self-regulation of brain activity, may be beneficial in elderly patients with mild cognitive impairment (MCI). In this pilot study, we investigated whether a sensorimotor (SMR)/theta NF training could improve cognitive performance and brain electrical activity in elderly patients with MCI. Methods: Twenty elderly patients with MCI were assigned to 20 consecutive sessions of sensorimotor (SMR)/theta NF training, during 10 weeks, on a basis of two sessions each week. Neuropsychological assessments and questionnaires, as well as electroencephalogram (EEG), were performed and compared between baseline (T0), after the last NF training session at 10 weeks (T1), and 1-month follow-up (T2). Results: Repeated measures ANOVA revealed that from baseline to post-intervention, participants showed significant improvement in the Montreal cognitive assessment (MoCa, F = 4.78; p = 0.012), the delayed recall of the Rey auditory verbal learning test (RAVLT, F = 3.675; p = 0.032), the Forward digit span (F = 13.82; p < 0.0001), the Anxiety Goldberg Scale (F = 4.54; p = 0.015), the Wechsler Adult Intelligence Score-Fourth Edition (WAIS-IV; F = 24.75; p < 0.0001), and the Mac Nair score (F = 4.47; p = 0.016). EEG theta power (F = 4.44; p = 0.016) and alpha power (F = 3.84; p = 0.027) during eyes-closed resting-state significantly increased after the NF training and showed sustained improvement at a 1-month follow-up. Conclusion: Our results suggest that NF training could be effective to reduce cognitive deficits in elderly patients with MCI and improve their EEG activity. If these findings are confirmed by randomized controlled studies with larger samples of patients, NF could be seen as a useful non-invasive, non-pharmacological tool for preventing further decline, rehabilitation of cognitive function in the elderly. Clinical Trial Registration: This pilot study was a preliminary step before the trial registered in www.ClinicalTrials.gov, under the number of NCT03526692.

[Exploring the impact of a group-based tablet-PC training program in older adults]. / Impact d'un programme de formation de groupe à l'utilisation de la tablette numérique chez des personnes âgées.

OBJECTIVES: There are several barriers to older adults using internet and information and communication technology (ICT). It has been suggested that appropriate training is necessary to support the learning process and is an important issue with regards to digital inclusivity for older adults. This study explored the impact of a tablet-PC training program for older adults, provided in a group setting. RESULTS: Thirteen community-dwelling older adults attended the program (ten one and half hour training sessions, taking place once every 2 weeks) and completed pre- and post- assessments. After the intervention, participants showed significantly higher levels of ICT acceptance (87.6 vs. 113.5, p=0.002) and proficiency (109.5 vs. 132.7, p=0.003) than before the intervention. However, they did not showed improvement in feelings of loneliness, symptoms of depression and global cognitive function. Qualitative analyses indicated that the intervention enabled older adults to become more up to date with the information society and promoted tablet-PC acceptance. Although it helped older adults to feel less isolated, it did not enable them to form genuine friendships. CONCLUSION: The intervention was effective in improving older adults' digital literacy and promoting ICT acceptance, allowing the digital divide to be narrowed.

Cognitive Function and Digital Device Use in Older Adults Attending a Memory Clinic.

This study investigated cognitive function in relation to the use of a computer and a touchscreen device among older adults attending a memory clinic. The entire sample (n = 323) was categorized into four profiles, according to the frequency of digital device use (either daily or non-daily usage). Results showed that on a daily basis, 26% of the sample used both a computer and a touchscreen device, 26.9% used only a computer, 7.1% used only a touchscreen device, and 39.9% used neither type of digital device. There were significant group differences on age, education, and clinical diagnosis (p < .001). Non-daily users of digital devices had significantly lower performance, compared with daily users of both types of digital device, on measures of global cognitive function, processing speed, short-term memory, and several components of executive function (p < .001). Falling behind with regard to the use of digital devices might reflect underlying poor cognitive capacities.

Differential effects of a computerized cognitive stimulation program on older adults with mild cognitive impairment according to the severity of white matter hyperintensities.

OBJECTIVE: This study aimed to explore whether a computerized cognitive stimulation program (CCS) induced differential effects in older adults with mild cognitive impairment (MCI) according to the severity of white matter hyperintensities (WMH), which are associated with cognitive impairment and increased risk of progression to Alzheimer's disease because of the damage they cause to cortical and subcortical networks. PATIENTS AND METHODS: Twenty-nine MCI patients with no or little WMH (MCI-non-WMH) and 22 MCI patients with moderate or severe WMH (MCI-WMH) attended a 24-session CCS program (two sessions per week for a duration of 3 months) focused on executive functions, attention, and processing speed. Cognitive and psychosocial assessments were performed at baseline, postintervention, and 3 months after the intervention. RESULTS: Both groups improved on several cognitive measures after the intervention. However, the MCI-non-WMH group improved on a higher number of cognitive measures than the MCI-WMH group. At postintervention assessment, CCS had a more beneficial effect on the MCI-non-WMH group than on the MCI-WMH group with regard to improving categorical fluency (4.6±6.8 vs 0.4±6.4; effect size=0.37; p=0.002). During the 3-month follow-up assessment, significantly higher score improvements were observed in the MCI-non-WMH group for the paired-associate learning test (6.4±3 vs 4.7±3.5 points; effect size=0.43; p=0.005) as well as categorical fluency (3.8±7.8 vs -0.7±6 points; effect size=0.55; p=0.0003). CONCLUSIONS: These findings suggest that WMH severity was related to cognitive improvement induced by a CCS program and highlight the importance of considering WMH in interventional studies on subjects with MCI.

Computerized cognitive stimulation and engagement programs in older adults with mild cognitive impairment: comparing feasibility, acceptability, and cognitive and psychosocial effects.

PURPOSE: Mild cognitive impairment (MCI) is associated with a higher risk of dementia and is becoming a topic of interest for pharmacological and nonpharmacological interventions. With advances in technology, computer-based cognitive exercises are increasingly integrated into traditional cognitive interventions, such as cognitive training. Another type of cognitive intervention involving technology use is cognitive engagement, consisting of involving participants in highly motivational and mentally challenging activities, such as learning to use a form of new digital technology. This study examined the feasibility and acceptability of a computerized cognitive stimulation (CCS) program and a computerized cognitive engagement (CCE) program, and then compared their effects in older adults with MCI. PATIENTS AND METHODS: In this randomized study, data from 19 MCI patients were analyzed (n=9 in CCS and n=10 in CCE). The patients attended a group weekly session for a duration of 3 months. Assessments of cognitive and psychosocial variables were conducted at baseline (M0) and at the end of the programs (M3). RESULTS: All of the participants attended the 12 sessions and showed a high level of motivation. Attrition rate was very low (one dropout at M3 assessment). At M3, the CCS participants displayed a significant improvement in part B of the Trail Making Test (TMT-B; p=0.03) and self-esteem (p=0.005), while the CCE participants showed a significant improvement in part A of the Trail Making Test (TMT-A; p=0.007) and a higher level of technology acceptance (p=0.006). The two groups did not differ significantly (p>0.05) in cognitive and psychosocial changes after the intervention. However, medium effect sizes (Cohen's d=0.56; 95% CI =-0.43:1.55) were found on the free recall, favoring the CCS group, as well as on TMT-A (d=0.51; 95% CI =-0.48:1.49) and technology acceptance (d=-0.65; 95% CI =-1.64:0.34), favoring the CCE group. CONCLUSION: Both interventions were highly feasible and acceptable and allowed improvement in different aspects of cognitive and psychosocial functioning in MCI subjects.

Can a tablet-based cancellation test identify cognitive impairment in older adults?

BACKGROUND AND OBJECTIVE: There has been a growing interest in using computerized cognitive assessment to detect age-related cognitive disorders. We have developed a tablet-based cancellation test (e-CT), previously shown as a reliable measure of executive functions and free of effect of familiarity with computer-based devices in healthy older adults. This study aimed to investigate the influence of demographics and current daily use of computer-based devices in older adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). We further studied the ability of the e-CT to discriminate MCI and AD patients from older adults with normal cognition (NC). METHODS: The e-CT was administered to 325 older adults (NC = 112, MCI = 129, AD = 84). Subjects also performed the K-T test, a paper-and-pencil cancellation test from which the e-CT was developed. Multiple linear regression analyses were conducted to assess the contribution of demographics and current daily use of computer-based devices on the e-CT in patient groups. The Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) were established to compare the efficacy of the e-CT and the K-T test to classify subjects into diagnostic groups. RESULTS: In the MCI group, age (B = -0.37, p<0.001) and current daily use of computer-based devices (B = 5.85, p<0.001) were associated with the number of correct cancellations of the e-CT. In the AD group, only current daily use of a computer-based device was a significant contributor (B = 6.28, p<0.001). The e-CT (AUC = 0.811; 95% confidence interval [CI]: 0.756-0.867) and the K-T (AUC = 0.837; CI: 0.787-0.887) showed good and comparable diagnostic accuracy to discriminate between MCI and NC subjects. To discriminate between NC and AD, both tests showed high diagnostic accuracy, with the AUC values of 0.923 (CI: 0.876-0.971) and 0.929 (95%CI: 0.886-0.972) for the e-CT and the K-T, respectively. CONCLUSION: The e-CT presents satisfying discriminative validity and is a promising tool for detection of early cognitive impairment in older adults.

Maintaining Cognitive Functioning in Healthy Seniors with a Technology-Based Foreign Language Program: A Pilot Feasibility Study.

Researchers have hypothesized that learning a foreign language could be beneficial for seniors, as language learning requires the use of extensive neural networks. We developed and qualitatively evaluated an English training program for older French adults; our principal objective was to determine whether a program integrating technology is feasible for this population. We conducted a 4-month pilot study (16, 2-h sessions) with 14 French participants, (nine women, five men, average age 75). Questionnaires were administered pre- and post-intervention to measure cognitive level and subjective feelings of loneliness or social isolation; however, these scores did not improve significantly. Post-intervention, semi-directive interviews were carried out with participants, and a content/theme analysis was performed. Five main themes were identified from the interviews: Associations with school, attitudes toward English, motivation for learning English, attitudes toward the program's organization, and social ties. The program was found to be feasible for this age group, yet perceived as quite difficult for participants who lacked experience with English. Nonetheless, most participants found the program to be stimulating and enjoyable. We discuss different suggestions for future programs and future directions for foreign-language learning as a therapeutic and cognitive intervention.

Clinical utility of the K-T cancellation test in a memory clinic population.

BACKGROUND/AIM: The K-T cancellation test (K-T) has been validated as a measure of executive functions (EF) but its clinical utility has not yet been examined. This study aimed to validate K-T in a memory clinic setting by examining its capacity to discriminate older adults with normal cognition (NC) from those with mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHOD: K-T was administered to 120 NC subjects, 146 patients with MCI, and 93 patients with AD. A one-way analysis of covariance was used to compare the correct cancellations of K-T between the groups. Linear regressions were run to identify significant demographic predictors of K-T for NC subjects and to determine the equation to calculate z scores for all subjects. The area under the curve (AUC), sensitivity (Se), specificity (Sp), and positive (PPV) and negative (NPV) predictive values were assessed to compare the diagnostic performance between K-T and the Mini-Mental State Examination (MMSE) for discrimination between NC subjects and patients with cognitive impairment. RESULTS: After adjusting for age, education, and gender, the groups were significantly different from each other regarding the number of correct cancellations of K-T, F(2, 353) = 116.6, p < .001, η(2)p = .40. Compared to the NC group (Z = 0, SD = 1), the mean z score was -1.52 for the MCI group and -2.53 for the AD group, suggesting impaired performance for the patient groups. K-T showed a better diagnostic performance for discrimination between the NC subjects and the patients with MCI (AUC = .83; 95% CI [.79, .88]; Se = .79; Sp = .74; PPV = .79; NPV = .74), compared to that of MMSE (AUC = .74, 95% CI [.68, .80]; Se = .68; Sp = .73; PPV = .79; NPV = .64). CONCLUSION: The K-T cancellation test showed a good diagnostic performance in discriminating cognitively normal older adults from cognitively impaired patients. Our findings support the clinical utility of K-T in geriatric neuropsychological assessment for detection of early cognitive impairment.

The Attitudes and Perceptions of Older Adults With Mild Cognitive Impairment Toward an Assistive Robot.

The purpose of this study was to explore perceived difficulties and needs of older adults with mild cognitive impairment (MCI) and their attitudes toward an assistive robot to develop appropriate robot functionalities. Twenty subjects were recruited to participate in either a focus group or an interview. Findings revealed that although participants reported difficulties in managing some of their daily activities, they did not see themselves as needing assistance. Indeed, they considered that they were capable of coping with difficulties with some compensatory strategies. They therefore declared that they did not need or want a robot for the moment but that they considered it potentially useful either for themselves in the future or for other older adults suffering from frailty, loneliness, and disability. Factors underlying unwillingness to adopt an assistive robot were discussed. These issues should be carefully addressed in the design and diffusion processes of an assistive robot.

A Tablet-PC-Based Cancellation Test Assessing Executive Functions in Older Adults.

OBJECTIVE: To examine older adults' performance on a newly developed tablet-PC-based cancellation test (e-CT) and to study its psychometric properties. METHODS: 94 older adults with normal cognitive functioning were recruited. The effects of age, education, sex, and experience with computer-based devices on the e-CT were examined. Construct validity was tested by correlating the e-CT with established measures of executive functions (EF) and episodic memory. Correlation coefficients were used to assess short-term test-retest reliablity. RESULTS: The mean age of participants was 74.6 (SD: 7.3) years and 78% were women. Sixty-nine percent had higher education level (> high school) and 76% used computer-based devices daily. The correct cancellations (CC) on the e-CT ranged from 18 to 56, with a mean (SD) of 40.3 (5.7). The CC was inversely correlated with advancing age (rs = -0.59, N = 94, p <0.001) and positively associated with higher education level (U(94) = 646.5, p = 0.02). No relationship was observed between the e-CT and sex or computer-based device experience. In multivariate analysis, only age remained significantly associated with CC (ß = -0.46, SE = 0.07, t = -6.47, df = 93, p <0.001). The e-CT correlated significantly with most of measures of EF. Highest correlations were found between the e-CT and the K-T test, a paper-and-pencil cancellation test (rs = 0.63, N = 90, p <0.001) and TMT-B (rs = -0.41, N = 85, p <0.001). The e-CT did not correlate with the RL-RI 16 episodic memory test. The correlation between the first and second e-CT indicated good reliability (rs = 0.89, N = 13, p <0.001). CONCLUSIONS: Results suggested that e-CT has good psychometric properties and may be useful for assessing EF in older adults.

The perceptions of cognitively impaired patients and their caregivers of a home telecare system.

Assistive and telecare technologies have been developed to support older adults with cognitive impairments, as well as their caregivers, from their homes. The way potential users perceive telecare and smart home systems plays a key role in their acceptance of this new technology. We evaluate the acceptance of home telecare technologies among patients suffering from cognitive impairment and their caregivers. Prototypes of telecare devices were developed to demonstrate their features and capabilities and to train patients, families, and health care professionals in their use. We conducted semistructured interviews to elicit the perceptions of 30 patients with mild cognitive impairment, 32 patients with Alzheimer's disease, and 30 caregivers, regarding the risks and advantages of home telecare and smart houses. Survey results reflected participants' largely positive reactions to these technologies. Regarding home telecare, the cognitive stimulation program earned the highest proportion of positive responses, followed by the devices' care of emergencies. The participants generally agreed that home telecare and smart houses could significantly improve their quality of life. However, some technical and ethical concerns, such as the way of provision, installation, and monitoring of the systems, were reported to be in need of addressing before implementation of this system.

Bridging the digital divide in older adults: a study from an initiative to inform older adults about new technologies.

PURPOSE: In a society where technology progresses at an exponential rate, older adults are often unaware of the existence of different kinds of information and communication technologies (ICTs). To bridge the gap, we launched a 2-year project, during which we conducted focus groups (FGs) with demonstrations of ICTs, allowing older adults to try them out and to share their opinions. This study aimed at investigating how participants perceived this kind of initiative and how they reacted to different kinds of ICTs. PATIENTS AND METHODS: In total, 14 FGs were conducted with community-dwelling older adults, with a frequency of two FGs on the same topic once per trimester. Twenty-three older adults (four men and 19 women) attended at least one FG but only nearly half of them were regular attendants (ten participating in at least five sessions). Age of participants ranged from 63 years to 88 years, with a mean of 77.1 years. All of them had completed secondary education. The analyses of the data were performed according to inductive thematic analysis. RESULTS: Four overarching themes emerged from the analysis. The first concerned participants' motivation for and assessment of the project. The second theme identified the underlying factors of the "digital divide" between the younger and the older generations. The third theme concerned the factors of technology adoption among older adults. The fourth one identified participants' attitudes toward assistive ICTs, designed specifically for older adults ("gerontechnologies"). DISCUSSIONS AND CONCLUSION: This project encouraging older adults to be informed about different kinds of ICTs was positively rated. With regard to ICTs, participants perceived a digital divide. The underlying factors are generation/cohort effects, cognitive and physical decline related to aging, and negative attitudes toward technologies. However, more and more older adults adopt different kinds of ICTs in order to fit in with the society. Concerning assistive ICTs, they manifested a lack of perceived need and usefulness. Also, there was a negative image of end users of this kind of technologies. The so-called gerontechnologies specifically targeting older adults contain stigmatizing symbolism that might prevent them from adopting them.

Is Mild Dementia Related to Unsafe Street-Crossing Decisions?

The overrepresentation of very old people (75 or older) in pedestrian crash statistics raises the issue of the effects of normal and pathologic ageing on gap-selection difficulties during street crossing. The present study focused on Alzheimer disease, a condition commonly associated with cognitive declines detrimental to daily life activities such as crossing the street. Twenty-five participants with mild dementia and 33 controls carried out a street-crossing task in a simulated environment. They also took a battery of cognitive tests. The mild-dementia group was more likely than the control group to make decisions that led to collisions with approaching cars, especially when the traffic was coming from 2 directions and they were in the far lane. Regression analyses demonstrated that the increased likelihood of collisions in the dementia group was associated with impairments in processing-speed and visual-attention abilities assessed on the Useful Field of View test. This test has already proven useful for predicting driving outcomes, falls, and street-crossing difficulties in healthy old adults, and among drivers with Alzheimer disease. Clinicians are encouraged to use it to help estimate whether a patient can drive, walk, and cross a street safely.

[DAD-6: an abbreviated version of the DAD scale (disability assessment for dementia). An instrument for detection of loss of autonomy at an early stage]. / DAD-6 : version abrégée de la DAD (disability assessment for dementia) Outil de détection d'une perte d'autonomie précoce.

This paper presents the French version of DAD-6, a validated instrument for the assessment of IADL (instrumental activities of daily living) considered as intentional and complex activities. A loss of autonomy remains a major criterion in the diagnosis of dementia. In addition, IADL assessment is recommended as a primary outcome in dementia drug trials. Since the publication in 1969 by Lawton and Brody of an IADL scale, many instruments have been developed. However, their psychometric properties remain to be improved. The need for improving the early diagnosis yielded to the design of DAD-6, an instrument allowing capturing subtle difficulties in IADL management. The DAD-6 scale emphasizes the role of the cognitive function, mainly the executive function in early IADL impairment. DAD-6 requires the participation of an informant (a patient's proxy). Relative to patients' self-reports or performance-based methods, informant-based questionnaires are the most common and practical methods used in memory clinics. In previous work, DAD-6 score gradually decreased with increasing severity of the cognitive status. The present work shows the inter-rater reliability of DAD-6. The use of the scale with the same informants by one neurologist and two neuropsychologists, separately, indicated a high agreement between raters (alpha of Krippendorff>0.80).This work also highlights the main sources of bias in the context of evaluation based on subjective judgement. The authors stress the necessity of: 1--a clarification of the relationship between cognitive function and IADL; 2--the measurement of IADL performance in a routine neuropsychological assessment by experienced professionals.

Acceptance of an assistive robot in older adults: a mixed-method study of human-robot interaction over a 1-month period in the Living Lab setting.

BACKGROUND: There is growing interest in investigating acceptance of robots, which are increasingly being proposed as one form of assistive technology to support older adults, maintain their independence, and enhance their well-being. In the present study, we aimed to observe robot-acceptance in older adults, particularly subsequent to a 1-month direct experience with a robot. SUBJECTS AND METHODS: Six older adults with mild cognitive impairment (MCI) and five cognitively intact healthy (CIH) older adults were recruited. Participants interacted with an assistive robot in the Living Lab once a week for 4 weeks. After being shown how to use the robot, participants performed tasks to simulate robot use in everyday life. Mixed methods, comprising a robot-acceptance questionnaire, semistructured interviews, usability-performance measures, and a focus group, were used. RESULTS: Both CIH and MCI subjects were able to learn how to use the robot. However, MCI subjects needed more time to perform tasks after a 1-week period of not using the robot. Both groups rated similarly on the robot-acceptance questionnaire. They showed low intention to use the robot, as well as negative attitudes toward and negative images of this device. They did not perceive it as useful in their daily life. However, they found it easy to use, amusing, and not threatening. In addition, social influence was perceived as powerful on robot adoption. Direct experience with the robot did not change the way the participants rated robots in their acceptance questionnaire. We identified several barriers to robot-acceptance, including older adults' uneasiness with technology, feeling of stigmatization, and ethical/societal issues associated with robot use. CONCLUSION: It is important to destigmatize images of assistive robots to facilitate their acceptance. Universal design aiming to increase the market for and production of products that are usable by everyone (to the greatest extent possible) might help to destigmatize assistive devices.

Does cognitive function increase over time in the healthy elderly?

BACKGROUND: In dementia screening, most studies have focused on early cognitive impairment by comparing patients suffering from mild dementia or mild cognitive impairment with normal subjects. Few studies have focused on modifications over time of the cognitive function in the healthy elderly. The objective of the present study was to analyze the cognitive function changes of two different samples, born > 15 years apart. METHOD: A first sample of 204 cognitively normal participants was recruited in the memory clinic of Broca hospital between 1991 and 1997. A second sample of 177 cognitively normal participants was recruited in 2008-2009 in the same institution. Both samples were from the same districts of Paris and were assessed with the same neuropsychological test battery. Mean cognitive test scores were compared between 1991 and 2008 samples, between < 80 years old and ≥ 80 years old in 1991 and 2008 samples, and finally between subjects < 80 year old of 1991 sample and subjects ≥ 80 years old of the 2008 sample. Means were compared with T-tests stratified on gender, age-groups and educational level. RESULTS: Cognitive scores were significantly higher in the 2008 sample. Participants < 80 years old outperformed those ≥ 80 in both samples. However, participants < 80 years old in 1991 sample and subjects ≥ 80 in the 2008 sample, born on average in 1923, performed mostly identically. CONCLUSION: This study showed a significant increase of cognitive scores over time. Further, contemporary octogenarians in the later sample performed like septuagenarians in the former sample. These findings might be consistent with the increase in life expectancy and life span in good health. The study highlights the necessity to take into account factors which may contaminate and artificially inflate the age-related differences in favor of younger to the older adults.

The K-T cancellation test in the older adults: Normative data and construct validity.

Since cutoff scores are necessary for differentiating normal cognitive functioning from dementia, the main objective of this study was to establish normative data of the K-T test, a standardized cancellation test. The construct validity of K-T test was also investigated. In total, 2471 cognitively intact elderly subjects from the SU.VI.MAX 2 study were included in the present study. Younger subjects, women and subjects with higher education had a higher number of correct answers and fewer omission errors. Participants made few commission errors and only the educational level was found to have a significant effect. Normative data for correct responses and efficiency were stratified by age, education, and gender. Correlation analysis showed that the K-T test was significantly correlated to validated neuropsychological tests assessing executive functions. This study permits to strengthen the utility of the K-T test to detect impairment of the executive components involved in the task.

Designing robots for the elderly: appearance issue and beyond.

This paper provides the results of three focus groups organized in the framework of the ROBADOM project, aiming at designing a service type assistive robot for the elderly with mild cognitive impairment living at home. The main objective of these focus groups was to give some recommendations to engineers in charge of the design of the robot's appearance. Results showed that although many humanoid robots were criticized by most participants, some small creative humanoid robots were appreciated. However, beyond the issue of the robot appearance, many ethical and social issues were raised. These focus groups offered an opportunity for participants to discuss the very idea of an assistive robot and to challenge some implicit preconceptions of the roboticists. Finally, we discuss how assistive robots could be designed considering the social context of the elderly and how to implicate the elderly as future end-users in the design process.

[Support for patients with Alzheimer's disease and their caregivers by gerontechnology]. / L'aide aux personnes souffrant de maladie d'Alzheimer et à leurs aidants par les gérontechnologies.

The increasing number of people suffering from Alzheimer's disease raises the question of their caring at home, especially when the disease causes disability and negative consequences in daily life such as isolation, falls, wandering, errors in drug taking. Furthermore, caregivers bear a substantial burden that can have adverse effects on their physical and mental health. New technologies of information could play an additional role as care providers without substituting family or professional caregivers help. A review of literature focused on the different technological solutions conceived for patients suffering from Alzheimer's disease and their carers shows that these appliances could help to provide reminders in daily life (drugs, tasks and appointments, meals cooking), to activate residual cognitive resources by computerized cognitive stimulation intervention, to reduce stress, anxiety and depressive symptoms in patients by visual contact with families and professionals (webconference), to contribute to patients safety by detecting falls and wandering, and to help families in the caring of patients with computerized information and counselling interventions. We also discuss the current limitations for a widespread use of these technologies and outline future research avenues. True needs of end-users are still poorly known and should be more clearly defined. Simplicity of the use of these appliances should be further improved. Demonstration of medical and social benefits for elderly people should be carried out in randomized, controlled studies. Ethical reflexion should be developed in conjunction with the use of these gerontechnologies. Finally, the economical model which would enable the providing of these appliances to the largest number of patients and caregivers should be implemented. Although these gerontechnologies are promising, research is still needed to tailor them properly to the needs of end-users, assess their benefit in ecological context of people with Alzheimer's disease in order to provide them with appropriate tools in daily life.