Project VITAL at Home: Impact of Technology on Loneliness and Well-Being of Family Caregivers of People with Dementia.

OBJECTIVES: Project VITAL At Home aimed to combat social isolation and loneliness in family caregivers of people with dementia through purposeful engagement and connection. This project examined the effects of technology on caregiver loneliness and well-being, as well as their technology experiences, during the COVID-19 pandemic. METHODS: Family caregivers were provided iN2L tablets and access to Alzheimer's Association supportive programs. Caregivers (n = 124) completed online surveys at pre and post evaluation points (average 7 months apart) to assess loneliness, subjective well-being (affect), supportive program usage, and tablet experiences. RESULTS: Family caregivers had positive perceptions of the tablets for both themselves and their family members. Tablets had positive effects on caregiver well-being, including giving them an additional caregiver tool, alleviating stress, increasing satisfaction with quiet time, and improving access to supportive programs. Caregiver positive affect decreased, but no changes were observed for negative affect or loneliness. CONCLUSIONS: Family caregivers found value in the tablets and showed improvements in some aspects of well-being. Randomized trials are needed to more fully assess the benefits of the intervention. CLINICAL IMPLICATIONS: Pairing tablets with caregiving supports is a promising intervention to improve caregivers' access to vital resources and services and to improve their well-being.

Disrupted Value-Directed Strategic Processing in Individuals with Mild Cognitive Impairment: Behavioral and Neural Correlates.

Value-directed strategic processing involves attending to higher-value information while inhibiting lower-value information. This preferential processing is relatively preserved in cognitively normal older adults but is impaired in individuals with dementia. No studies have investigated whether value-directed strategic processing is disrupted in earlier stages of cognitive decline, namely, mild cognitive impairment (MCI). The current study examined behavioral and EEG differences in value-directed strategic processing between 18 individuals with MCI and 18 cognitively normal older controls using a value-directed list learning task. Behaviorally, individuals with MCI recalled fewer total and high-value words compared to controls, but no group differences were observed in low-value word recall. Neurally, individuals with MCI had reduced theta synchronization relative to controls between 100 and 200 ms post-stimulus. Greater alpha desynchronization was observed for high- versus low-value words between 300 and 400 ms in controls but not in the MCI group. The groups showed some processing similarities, with greater theta synchronization for low-value words between 700 and 800 ms and greater alpha desynchronization for high-value words between 500 and 1100 ms. Overall, value-directed strategic processing was compromised in individuals with MCI on both behavioral and neural measures relative to controls. These findings add to the growing body of literature on differences between typical cognitive aging and MCI.

EEG theta and alpha oscillations in early versus late mild cognitive impairment during a semantic Go/NoGo task.

Amnestic mild cognitive impairment (aMCI) is marked by episodic memory deficits, which can be used to classify individuals into early MCI (EMCI) and late MCI (LMCI). Although mounting evidence suggests that individuals with aMCI have additional cognitive alterations including deficits in cognitive control, few have examined if EMCI and LMCI differ on processes other than episodic memory. Using a semantic Go/NoGo task, we examined differences in cognitive control between EMCI and LMCI on behavioral (accuracy and reaction time) and neural (scalp-recorded event-related oscillations in theta and alpha band) measures. Although no behavioral differences were observed between the EMCI and LMCI groups, differences in neural oscillations were observed. The LMCI group had higher theta synchronization on Go trials at central electrodes compared to the EMCI group. In addition, the EMCI group showed differences in theta power at central electrodes and alpha power at central and centro-parietal electrodes between Go and NoGo trials, while the LMCI group did not exhibit such differences. These findings suggest that while behavioral differences may not be observable, neural changes underlying cognitive control processes may differentiate EMCI and LMCI stages and may be useful to understand the trajectory of aMCI in future studies.

Cognitive Flexibility and Inhibition in Individuals with Age-Related Hearing Loss.

Growing evidence suggests alterations in cognitive control processes in individuals with varying degrees of age-related hearing loss (ARHL); however, alterations in those with unaided mild ARHL are understudied. The current study examined two cognitive control processes, cognitive flexibility, and inhibition, in 21 older adults with unaided mild ARHL and 18 age- and education-matched normal hearing (NH) controls. All participants underwent comprehensive audiological and cognitive evaluations including Trail Making Test-B, Verbal Fluency, Stroop, and two Go/NoGo tasks. Group differences in cognitive flexibility and inhibition as well as associations between peripheral and central hearing ability and measures of cognitive flexibility and inhibition were investigated. Findings revealed that the ARHL group took significantly longer to complete the Stroop task and had higher error rates on NoGo trials on both Go/NoGo tasks relative to the NH controls. Additionally, poorer peripheral and central hearing were associated with poorer cognitive flexibility and inhibitory control. Our findings suggest slower and more inefficient inhibitory control in the mild ARHL group relative to the NH group and add to decades of research on the association between hearing and cognition.

An Integrative Framework to Guide Social Engagement Interventions and Technology Design for Persons With Mild Cognitive Impairment.

Social isolation and loneliness in older adults are associated with poor health outcomes and have been linked to an increased risk of cognitive impairment and incident dementia. Social engagement has been identified as a key factor in promoting positive health behaviors and quality of life and preventing social isolation and loneliness. Studies involving cognitively healthy older adults have shown the protective effects of both in-person and technology-based social engagement. However, the benefits of social engagement for people who are already at-risk of developing dementia, namely those with mild cognitive impairment (MCI), have yet to be elucidated. We present a narrative review of the literature, summarizing the research on social engagement in MCI. First, we identified social networks (quality, size, frequency, and closeness) and social activities (frequency, format, purpose, type, and content) as two overarching dimensions of an integrative framework for social engagement derived from literature examining typical cognitive aging. We then used this framework as a lens to examine studies of social engagement in MCI to explore (i) the relationship between in-person and technology-based social engagement and cognitive, emotional, and physical health, and (ii) interventions that target social engagement including technology-based approaches. Overall, we found that persons with MCI (PwMCI) may have different levels of social engagement than those experiencing typical cognitive aging. Moreover, in-person social engagement can have a positive impact on cognitive, emotional, and physical health for PwMCI. With respect to activity and network dimensions in our framework, we found that cognitive health has been more widely examined in PwMCI relative to physical and emotional health. Very few intervention studies have targeted social engagement, but both in-person and technology-based interventions appear to have promising health and well-being outcomes. Our multidimensional framework of social engagement provides guidance for research on characterizing the protective benefits of social engagement for PwMCI and informs the development of novel interventions including technology-based approaches.

Alzheimer's Association Project VITAL: A Florida Statewide Initiative Using Technology to Impact Social Isolation and Well-Being.

Lack of social engagement and the resulting social isolation can have negative impacts on health and well-being, especially in senior care communities and for those living with dementia. Project VITAL leverages technology and community resources to create a network for connection, engagement, education, and support of individuals with dementia and their caregivers, and explores the impact of these interventions in reducing feelings of social isolation and increasing mood among residents during the COVID-19 pandemic. Through two phases, 600 personalized Wi-Fi-enabled iN2L tablets were distributed to 300 senior care communities (55% assisted living communities, 37% skilled nursing communities, 6% memory care communities, and 2% adult family-care homes) to connect and engage residents and their families. Different phases also included Project ECHO, a video-based learning platform, Alzheimer's Association virtual and online education and support for family caregivers, evidence-based online professional dementia care staff training and certification, and Virtual Forums designed to explore ways to build sustainable, scalable models to ensure access to support and decrease social isolation in the future. Tablet usage was collected over an 11-month period and an interim survey was designed to assess the effectiveness of the tablets, in preventing social isolation and increasing mood among residents during the COVID-19 pandemic. A total of 105 care community staff (whose community used the tablets) completed the survey and overall, these staff showed a high level of agreement to statements indicating that residents struggled with loneliness and mood, and that the tablet was useful in improving loneliness and mood in residents and allowing them to stay in touch with family and friends. Additional positive results were seen through a variety of other responses around the tablets and Project ECHO. Overall, the tablets were shown to be an effective way to engage residents and connect them with friends and family, as well as being a useful tool for staff members. A third phase is currently underway in the homes of people with dementia and their family caregivers, which includes tablets and direct access to Alzheimer's Association virtual and online education and support programs.

Investigating EEG theta and alpha oscillations as measures of value-directed strategic processing in cognitively normal younger and older adults.

Value-directed strategic processing is an ability that appears to be relatively preserved with aging, but the neurophysiological mechanisms underlying strategic processing in older adults are not well understood. The current study examined age-related spectral power differences in EEG oscillations linked to processing of high-value versus low-value information in a value-directed strategic processing task in 24 younger adults (mean age: 22.4 ± 1.2 years) and 24 older adults (mean age: 63.2 ± 6.4 years). Both groups exhibited comparable strategic processing ability behaviorally with preferential recall of high- compared to low-value words. Both groups exhibited comparable theta band power with greater synchronization for low- compared to high-value words, but age-related differences in processing were noted in alpha band power. Older adults showed more prolonged alpha desynchronization for high- compared to low-value words relative to younger adults. This neurophysiological modulation in the alpha band in older adults might reflect a compensatory neural mechanism or increased effort linked to selective engagement of neural resources, allowing them to perform similarly to younger adults behaviorally on a value-directed strategic processing task.

Design guidance for video chat system to support social engagement for older adults with and without mild cognitive impairment.

Background: Social engagement technologies offer an opportunity to reduce social isolation. However, there are barriers to adoption among older adults with and without Mild Cognitive Impairment (MCI). Technology designed to meet the needs of those users may improve the acceptability, adoption, and benefits of social engagement technology. Objective: The goal was to assess older adults' needs and preferences for using video chat systems. We used the Technology Acceptance Model as a framework for evaluating and optimizing usability of a web-based video chat system for older adults with and without MCI. Methods: Mixed methods (qualitative and quantitative) were used to achieve this objective. We developed questionnaires and interviews to identify experiences with video chat, and preferences and attitudes towards a web-based video chat system. We conducted heuristic analysis to evaluate and improve the usability of the system. Results: Participants reportedly used video chat less than other social network tools (e.g., Email). They were open to using a web-based video chat system to meet new people of all ages with shared interests. Their favorite topics of conversation were books, health, family, and exercise. Their ideal group size for a video chat session was 3 to 6 people. Overall, participants' attitudes toward the system were positive and they perceived the system as easy to use and useful for social engagement. Their evaluations indicated high usability of the system. However, individuals with MCI might require additional assistance to use the system. Usability issues were identified, such as technical terminology, small font size, and potentially confusing icons that were addressed in the redesign. Conclusion: Older adults, with and without MCI, were interested in using a social engagement technology to interact with previously unfamiliar individuals with shared interests. They provided valuable insights for the design of the systems. Our findings provide guidance for the design of social engagement technologies. Our research approach serves as a case study for the assessment of other technology platforms.

Theta and alpha band oscillations during value-directed strategic processing.

Strategic processing allows for value-based preferential encoding of information. Event-related spectral perturbations can provide insights into neural processes linked to the different aspects of strategic processing. This study examined theta and alpha band power differences linked to processing of high- versus low-value information. Thirty-three young adults (17 F; mean age: 21.2 ± 1.5 years) completed a value-directed word list learning task. The task consisted of five word lists that each contained a unique set of high- and low-value words that were visually presented one at a time and EEG corresponding to these words were examined. To encourage strategic processing, participants were informed that after each list they would be asked to recall as many words as possible with their goal being to maximize their score. Overall, participants recalled more high-value words for each of the five lists as compared to low-value words, which supports that participants engaged in strategic processing. Frontal theta band power showed greater positivity during processing of low- compared to high-value words, whereas parietal alpha band power showed greater negativity during processing of high- compared to low-value words. These findings suggest that theta and alpha bands index different aspects of strategic processing, namely inhibition and selective attention, and have future applications for understanding the effects of aging and brain diseases/disorders.

Effects of Traditional vs. iPad-Enhanced Aerobic Exercise on Wayfinding Efficacy and Cognition: A Pilot Randomized Controlled Trial.

The purpose of this pilot study was to test the feasibility and efficacy of an iPad-enhanced aerobic exercise intervention designed to enhance wayfinding efficacy and performance and relevant cognitive functioning among middle-aged adults at risk for cognitive impairment. Twenty-seven low active adults (21 females) aged 45 to 62 years (51.22 ± 5.20) participated in a ten-week randomized controlled trial. Participants were randomized to an iPad-enhanced aerobic exercise group (experimental group) or an aerobic exercise-only group (control group) following baseline assessment. Both groups exercised at 50% to 75% of age-predicted heart rate maximum for 30 to 50 min/d, 2 d/wk for 10 weeks. During aerobic exercise, the experimental group engaged in virtual tours delivered via iPad. Baseline and post-intervention assessments of wayfinding self-efficacy, wayfinding task performance, cognitive functioning, electroencephalogram (EEG), and psychosocial questionnaires were administered. The results suggest that ten weeks of iPad-enhanced, moderately intense aerobic exercise had specific effects on wayfinding self-efficacy; however, no statistical differences were found between groups on the behavioral wayfinding task or spatial memory performance at follow-up. Performance scores on an inhibitory attentional-control cognitive assessment revealed significant differences between groups, favoring the experimental group (p < 0.05). Virtual reality-enhanced aerobic exercise may prove to be an effective method for improving cognitive function and increasing confidence to navigate real-world scenarios among individuals at risk of cognitive impairment.

Event-related neural oscillation changes following reasoning training in individuals with Mild Cognitive Impairment.

Emerging evidence suggests cognitive training programs targeting higher-order reasoning may strengthen not only cognitive, but also neural functions in individuals with Mild Cognitive Impairment (MCI). However, research on direct measures of training-induced neural changes, derivable from electroencephalography (EEG), is limited. The current pilot study examined effects of Gist Reasoning training (n = 16) compared to New Learning training (n = 16) in older adults with amnestic MCI on measures of event-related neural oscillations (theta and alpha band power) corresponding to Go/NoGo tasks during basic and superordinate semantic categorization. EEG data were recorded while participants performed the Go/NoGo task pre- and post-training, and power in theta and alpha frequency bands was examined. Both groups were comparable at pre-training on all measures and both groups showed greater event-related theta synchronization post-training. Furthermore, the Gist Reasoning group had enhanced event-related desynchronization in low-frequency alpha band (8-10 Hz) on response inhibition (NoGo) trials and high-frequency alpha band (11-13 Hz) on response execution (Go) trials during superordinate categorization, relative to the New Learning group. These findings suggest that Gist Reasoning training in MCI impacted neural processing linked to strategic processing of Go and NoGo trials during the more complex superordinate categorization task. Targeting higher-order top-down cognitive processing seems to better harness residual neuroplastic potential in MCI. ClinicalTrials.gov ID: NCT02588209.

Auditory system dysfunction in Alzheimer disease and its prodromal states: A review.

Recent findings suggest that both peripheral and central auditory system dysfunction occur in the prodromal stages of Alzheimer Disease (AD), and therefore may represent early indicators of the disease. In addition, loss of auditory function itself leads to communication difficulties, social isolation and poor quality of life for both patients with AD and their caregivers. Developing a greater understanding of auditory dysfunction in early AD may shed light on the mechanisms of disease progression and carry diagnostic and therapeutic importance. Herein, we review the literature on hearing abilities in AD and its prodromal stages investigated through methods such as pure-tone audiometry, dichotic listening tasks, and evoked response potentials. We propose that screening for peripheral and central auditory dysfunction in at-risk populations is a low-cost and effective means to identify early AD pathology and provides an entry point for therapeutic interventions that enhance the quality of life of AD patients.

Theta and Alpha Alterations in Amnestic Mild Cognitive Impairment in Semantic Go/NoGo Tasks.

Growing evidence suggests that cognitive control processes are impaired in amnestic mild cognitive impairment (aMCI); however the nature of these alterations needs further examination. The current study examined differences in electroencephalographic theta and alpha power related to cognitive control processes involving response execution and response inhibition in 22 individuals with aMCI and 22 age-, sex-, and education-matched cognitively normal controls. Two Go/NoGo tasks involving semantic categorization were used. In the basic categorization task, Go/NoGo responses were made based on exemplars of a single car (Go) and a single dog (NoGo). In the superordinate categorization task, responses were made based on multiple exemplars of objects (Go) and animals (NoGo). Behavioral data showed that the aMCI group had more false alarms during the NoGo trials compared to controls. The EEG data revealed between group differences related to response type in theta (4-7 Hz) and low-frequency alpha (8-10 Hz) power. In particular, the aMCI group differed from controls in theta power during the NoGo trials at frontal and parietal electrodes, and in low-frequency alpha power during Go trials at parietal electrodes. These results suggest that alterations in theta power converge with behavioral deterioration in response inhibition, whereas alterations in low-frequency alpha power appear to precede behavioral changes in response execution. Both behavioral and electrophysiological correlates combined provide a more comprehensive characterization of cognitive control deficits in aMCI.

The Effects of Amnestic Mild Cognitive Impairment on Go/NoGo Semantic Categorization Task Performance and Event-Related Potentials.

We examined the effects of amnestic mild cognitive impairment (aMCI) on behavioral (response times and error rates) and scalp-recorded event-related potential (ERP) measures of response execution and inhibition, using Go/NoGo tasks involving basic and superordinate semantic categorization. Twenty-five aMCI (16 F; 68.5±8 years) and 25 age- and gender-matched normal control subjects (16 F; 65.4±7.1 years) completed two visual Go/NoGo tasks. In the single car task, responses were made based on single exemplars of a car (Go) and a dog (NoGo) (basic). In the object animal task, responses were based on multiple exemplars of objects (Go) and animals (NoGo) (superordinate). The aMCI subjects had higher commission errors on the NoGo trials compared to the control subjects, whereas both groups had comparable omission errors and reaction times during the Go trials. The aMCI subjects had significantly prolonged N2 ERP latency during Go and NoGo trials across tasks compared to the controls. Both groups showed similar categorization effects and response type effects in N2/P3 ERP latencies and P3 amplitude. Our findings indicate that altered early neural processing indexed by N2 latency distinguishes subjects with aMCI from controls during the Go/NoGo task. Prolonged Go-N2 latency in aMCI appears to precede behavioral changes in response execution, whereas prolonged NoGo-N2 latency underlies behavioral deterioration in response inhibition.