Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer’s

A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological... Hindawi Journal of Healthcare Engineering Volume 2018, Article ID 1536316, 9 pages https://doi.org/10.1155/2018/1536316 Research Article A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer’s 1 2 3,4 Danish Imtiaz, Arshia Khan , and Adriana Seelye George Washington Medical School, Washington, DC, USA Computer Science Department, University of Minnesota Duluth, Duluth, MN, USA University of Minnesota Twin Cities, Minneapolis, MN, USA Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA Correspondence should be addressed to Arshia Khan; akhan@d.umn.edu Received 4 August 2017; Accepted 2 January 2018; Published 21 March 2018 Academic Editor: Denise Ferebee Copyright © 2018 Danish Imtiaz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer’s. BPSD can include agitation, restlessness, aggression, apathy, obsessive-compulsive and repetitive behaviors, hallucinations, delusions, paranoia, and wandering. Alzheimer’s currently affects 5.4 million adults in the United States and that number is projected to increase to 14 million by 2050. Almost 90% of all affected with AD experience BPSD, resulting in increased healthcare costs, heavier burden on caregivers, poor patient outcomes, early nursing home placement, long-term hospitalizations, and misuse of medications. Pharmacological support may have undesirable side effects such as sedation. Nonpharmacological interventions are alternative solutions that have shown to be effective without undesirable side effects. Music therapy has been found to lower BPSD symptoms significantly. Our study is based on combination of the reminiscence and the music therapies where past memorable events are recalled using prompts such as photos, videos, and music. We are proposing a mobile multimedia solution, a technical version of the combined reminiscence, and music therapies to prevent the occurrence of BPSD, especially for the rural population who have reduced access to dementia care services. 1. Introduction need for caregiver also increases. More than 15 million family and friends of affected people provide care for the person Approximately 35.6 million people worldwide and more affected with AD. In 2016, over $236 billion dollars were than 5 million in the United States suffer from dementia. spent on dementia [1]. Indirect cost increase due to BPSD Every 66 seconds, a person in the United States develops in person affected with AD was 25% above the cost of AD, dementia [1]. Almost 90% of all affected with Alzheimer’s while the direct costs increase was 35% above the direct AD disease (AD) experience behavioral and psychological symp- costs [4]. toms of dementia (BPSD), resulting in increased healthcare As the disease progresses, many affected individuals costs, heavier burden on caregivers, poor patient outcomes, develop psychological problems in the form of behavior early nursing home placement, long-term hospitalizations, issues such as agitation, irritability, aggression, depression, and misuse of medications [2]. BPSD play a major role in delusions and hallucinations, wandering, and sleep disorders [5–7]. Among behavioral symptoms, approximately 88% of increasing burden on the caregivers of individuals affected with dementia [3]. BPSD is not only a contributor to care- the patients suffer from apathy, 66% suffer from aggression, giver distress but also a major cause for nursing home place- and 60% suffer from irritability, while among psychological ment [4]. As the number of affected people increases, the symptoms, 56% of patients suffer from depression, 55% 2 Journal of Healthcare Engineering suffer from delusions, and 52% suffer from anxiety. In one study, not only were behavioral symptoms found to be more prevalent, but these symptoms were also more stressful to caregivers than the psychological symptoms [7]. If these symptoms are not treated, they can reduce the quality of life, expedite functional decline, and cause early transfer to assisted living [1, 7, 8]. Of these symptoms, the most preva- lent and distressing were behavioral symptoms such as agita- tion, irritability, and apathy [9]. The stress process model identifies BPSD as the greatest source of stress on caregivers [10]. Persons with mild to moderate AD who are affected with BPSD often require frequent supervision, monitoring, and support. This poses several challenges, especially in rural parts of the country due to limitations in resources. Approx- imately 30% of the total costs for AD are from BPSD man- agement [4]. As per the US census of 2010, approximately 19.3% of the US population resides in rural areas that covers 97% of the land [11]. Due to the large distances between the rural communities, the residents in rural areas are faced with greater health care barriers than their urban counterparts. Some of the barriers experienced by the residents in rural areas are constrained access to care, limited resource avail- ability, overlapping clinician roles, long distance provider commute, and clinician training constraints [12]. Rural resi- dents face problems of not only scarcity of primary care pro- viders but also long distances between care providers and the rural communities [13]. In addition, rural areas have a pro- portionally larger elderly population (14.6% of the rural pop- Figure 1: Welcome page. ulation is 65 and above versus 11.7% of urban population) and hence a larger number of individuals affected with dementia and fewer health and social services. The goal of using prompts such as photos and music in group settings this project is to create a calming and relaxing effect while where a group leader would lead the session with other helping resurface embedded event memory in persons with friends and family of the affected individual and the event is gently reminded with cues from the event. Although tradi- AD by tackling distressing BPSD symptoms. Pharmacologi- cal support in the form of antipsychotic drugs can be used, tional reminiscence therapy has proved to help lower BPSD but these are not always helpful and may have side effects symptoms notably, it is not only time and resource intensive; such as sedation. Nonpharmacological solutions such as it is typically conducted in a group setting and requires reminiscence therapy and music therapy are encouraged in resources such as a trained group leader. We are proposing a variation of the reminiscence therapy where the group addressing BPSD. Music therapy has proved to lower BPSD in persons leader and the other family members are not required to be affected with dementia. In one study, music therapy was present each time the therapy is performed. Dr. Oliver Sack, applied for 16 weeks and subjects were evaluated by multidi- a neurologist, has promoted music as a powerful tool to stim- mensional assessment including minimental state examina- ulate and recall deeply embedded memory [16–20]. Irrespec- tion, Barthel index, and neuropsychiatry inventory. These tive of their stage in AD, all people are able to respond and subjects were observed to have a significant decrease in the react to musical stimulation in improving cognition, behav- NPI score, and the symptoms of agitation, irritation, apathy, ior, and mood in AD [18]. Research has shown individual- delusions, and hallucinations were greatly reduced [14]. ized music therapy is the most effective [19]. Our proposal Reminiscence therapy has been successfully used to help creates an individualized multisensory mobile multimedia address BPSD [15]. However, traditional reminiscence ther- environment that is tied to a specific memory event as seen apy is time consuming, which makes it difficult to imple- in Figures 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10. ment, especially in a rural setting. Additionally, this type of therapy is conducted in a group setting and requires 2. Related Work resources such as a trained group leader and other members who are skilled to work in this group. These resources are Technology has been proposed as a means of treating many often not available to community-dwelling older adults who facets of dementia, including challenging behaviors such as live in rural areas. anxiety, restlessness, agitation, sleep disturbances, and disori- Our proposal is based on two foundational concepts—re- entation, especially in regard to time and place and physical miniscence therapy and Dr. Oliver Sack’s music research. functioning [21, 22]. As can be seen, the scope of these tech- Reminiscence therapy is used to recall past memorable events nological innovations varies greatly. In addition to the scope, Journal of Healthcare Engineering 3 Figure 2: Patient information. Figure 4: Menu selection. Figure 3: Select patient. Figure 5: Media selection. 4 Journal of Healthcare Engineering Figure 6: Music source. Figure 8: Photo source. Figure 7: Music selection. Figure 9: Photo selection. Journal of Healthcare Engineering 5 Snoezelen, is a multisensory environment that seeks to reduce agitation and anxiety or stimulate reactions of com- munication in patients by creating a very engaging yet con- trolled environment. Snoezelen has been used to reduce challenging behavior among individuals affected with AD [26, 27]. Various studies have shown improvement in mood, behavior, and cognition after treatments. Patients’ communi- cation improved during the Snoezelen sessions, and patients showed improvements in both short- and long-term follow- up evaluations [28]. These studies illustrate the impact technology can have on management of BPSD and improv- ing the lives of those with dementia and their caregivers. The picture gramophone, a word processing solution, was a music-based multimedia tool that was developed in the 1990s to help improve the well-being in persons with dementia and displayed promising results [25]. Current technological solutions and support applications for caregivers do not address BPSD directly. The objective of our multimedia application is to stimulate deeply embedded memories by recreating events through use of music, images, and textual descriptions, for example, incorporating pictures of important events such as a wedding or birthday into a slideshow to reduce BPSD in persons with Alzheimer’s dis- ease. The objective of our project is to address BPSD in per- sons with AD by stimulating deeply embedded memories by recreating events through use of meaningful music and Figure 10: Photo display time. personalized images and textual descriptions. For example, we will incorporate pictures of important events such as a wedding or birthday into a slideshow that can calm the the approach utilized by these applications differs signifi- cantly. Among the investigated applications are care-team affected individual. communication tools, electronic encyclopedias, decision support applications for at-home caregivers, Internet-based 3. Framework support groups, home monitoring systems, human-to- human interaction tools, computer-based memory tools, We are proposing a framework to address BPSD in dementia audio and video tapes, and entertainment [21–24]. Of all such as agitation, irritability, and apathy by combining ther- the related technological innovations, two stood out as apies such as reminiscence and music therapies into a tech- strongly related to the proposed application. The first, devel- nological, affordable, personalized, and accessible mobile oped by a research team made up of professionals from the solution to reduce BPSD and their associated stress on care- National Research and Development Centre for Welfare givers. The uniqueness of this proposal is the design with and Health from Finland, Dementia Services Information respect to accessibility and affordability of a mobile applica- and Development Centre from Dublin, the Norwegian Cen- tion and the individualized nature of the music and reminis- tre for Dementia Research, and Dementia Voice from the cence therapy components. The caregiver can pick an United Kingdom evaluated the effectiveness of a music- important event in the life of the affected individual and based and multimedia program in dementia care centers in use cues, such as pictures, videos, and music, associated with the four represented countries with the primary aim of stim- that event. Cues help jog deeply embedded memories related ulating patients and to give them pleasure. This was a word to an event; for example, incorporating pictures of important processing editor called the picture gramophone and events such as a wedding or birthday into a slideshow can designed for a desktop with a CD drive, a keyboard, and a help the affected individual to calm down. Reminiscence mouse. Results showed that 91% of participants showed therapy and music therapies have proved to be very beneficial some form of benefit from the tool, in either mood or social in addressing BPSD and have been recommended to reduce interaction [25]. The application design varied from our BPSD. We are combining the concept of using prompts such proposed solution in that it was specialized to the region as objects and people in helping recall episodic-embedded and minimally modified to the individual but in no way memory from reminiscence therapy and the concept of individualized to the particular patient or events in that music helping in memory recall in persons affected with patient’s life, although the authors noted that this should AD as promoted by neurologist, Dr. Oliver Sack. We are pro- be a consideration for future developments. In addition, posing to incorporate the positive aspects of reminiscence because of logistics, this technology was available to patients and music therapies into a user-friendly mobile application only at the care center. Finally, some patients needed sup- that is affordable and easily accessible to caregivers and per- port when working with the tool. The second application, sons with AD. Pharmacological solutions are not encouraged 6 Journal of Healthcare Engineering Hypothesis: After engaging with the reminiscence ther- due to the undesirable side effects of sedation. Our proposal is a low-cost solution to address BPSD and help support care- apy app during an episode of BPSD, there will be a reduction givers. The mobile app will be designed for multiple mobile in neuropsychiatric symptoms as evidenced by caregiver- platforms such as iOS and Android. The challenges in this report ratings on a semistructured questionnaire. There will application will be the ability to select music/video/pictures be an overall reduction in neuropsychiatric symptoms over from the mobile user’s music playlist/photo/video library, the one-week period as evidenced by lower scores on vali- or if there is no music associated with this particular event, dated caregiver-report questionnaires assessing BPSD such and then performing a search to find music of the era of as the neuropsychiatric inventory (NPI; Cummings, 1994) and the revised memory and behavior checklist (RMBC; the same timeframe as the event for which the multisensory multimedia event is being created. Another challenge will Terri, 1992). be to design the user interface in a way that is user-friendly and accessible to the caregiver, who will most likely be an 4.2. Phase 2/Aim 2. Design a multisensory mobile appli- older adult and who may or may not have much computer cation that engages the person with AD and reduces caregiver burden. or smartphone experience. Also, it will be important to make the music/picture selection process a quick one, as caregivers Hypothesis: After engaging with the reminiscence ther- will likely want to address BPSD symptoms quickly once they apy app during an episode of BPSD, there will be a reduction occur. The caregiver will decide on an event such as a wed- in caregiver distress as evidenced by caregiver self-report rat- ding and find pictures, videos, and music-associated with this ings on a semistructured questionnaire. There will be an overall reduction in caregiver distress over the one-week event. These will be incorporated into a multimedia slide- show and played to the affected individual when he/she is period as evidenced by lower scores on validated self-report agitated, irritated or experiences apathy. questionnaires assessing BPSD-related caregiver distress such as the NPI and the RMBC. The mobile application is built for the Android plat- 4. Methods and Design form and is designed to be user-friendly so a caregiver can easily set up a patient and create the multimedia epi- In this two-phase exploratory study, a multisensory sodic happy memory event-based presentations for the multimedia-based mobile application has been developed for the Android mobile platform as seen in Figures 1, 2, 3, patients. Figure 1 shows the welcome page of the applica- tion when it firsts starts; Figure 2 gives user the option of 4, 5, 6, 7, 8, 9, and 10 for phase 1, while the clinical study will entering the information for a new patient as this applica- be conducted in phase 2. Only phase 1 will be described in this paper. Phase 1 will comprise of designing and building tion can be used for multiple individuals affected with AD; Figure 3 shows the screen where an existing patient can be the mobile application for multiple platforms, and phase 2 will comprise of the clinical study. The objective of phase 2 selected from a database of patients; Figure 4 shows where the caregiver has the choice of either choosing to create a new of the project is to stimulate deeply embedded event-based happy memory multimedia presentation or selecting from a episodic memories of persons affected with AD. The care- giver will pick an important memorable event from the life list of happy memories that were created in the past; the happy memory events created are unique to each patient of the affected individual and use cues, such as pictures and music, associated with that event to create a multisensory with their photos and music. Hence, this application can be customized to each individual’s needs making unique set multimedia show paired with music that was either from of episodic happy memories. Figure 5 shows the first screen the event or associated with the event. If there is no music associated with this event, then the application will find that appears when the caregiver chooses to create a new happy memory presentation, where the caregiver has a music of that period to create this multimedia show. The videos or photos will serve as prompts and cues to help jog choice of either selecting pictures for the new happy memory or music for this new presentation since various pictures and deeply embedded memories related to this event. An example or videos can be incorporated in the multisensory multime- of creating a multisensory multimedia show is selecting pictures and videos of important events such as a wedding dia event-based presentation. Figure 6 shows how the caregiver can select between or birthday into a slideshow that can help the affected indi- vidual to calm down. This calming effect potentially helps music databases to add music associated with this happy memory. Figure 7 shows the screen where the caregiver can the affected individual recall associated memories. The pro- select the music from the music library. Figure 8 shows the ject will be executed in two phases. The design is built on the following research question and hypotheses. screen for the photo selection while Figure 9 shows where the images/photos are selected. Finally, Figure 10 shows Research question: Can a multisensory mobile multime- dia reminiscence therapy app reduce the frequency of BPSD how the user can select the length of time of display for the images/photos. episodes by helping calm and reducing agitation, irritation, At clinical study (phase 2) entry, caregivers will com- and apathy by recreating an event/episodic memory in per- sons with AD? plete validated self-report measures assessing BPSD in their AD person over the past week and BPSD-related caregiver 4.1. Phase 1/Aim 1. Design a multisensory mobile application distress. Caregivers will provide study staff with pictures, that employs reminiscence therapy to reduce the frequency movies, music, and any other media that is meaningful to the AD participant’s past to be loaded on the multimedia of BPSD episodes in persons with AD. Journal of Healthcare Engineering 7 New user Entry point Welcome newUser() returningUser() Patient information Enter patient information saveInfo() Menu create() viewPrevious() Create multimedia View created show multimedia shows loadImgGallery() Android gallery Select images onActivityResult() Set image details Select multimedia (time/order) show to view loadSong() viewMultimediaShow() viewAnother() Select songs Android music onActivityResult() Set song details View it (time/order) viewMultimediaShow() Figure 11: Algorithm for the Happy Times Android application. app. After the media has been loaded on the study tablet, happy memory event presentation can be viewed. The user participants will be given the tablet equipped with the mul- then has a choice between selecting music or photos that timedia application to use in their home for one week. Any can be added to the happy memory. The algorithm shows time the AD participant experiences BPSD during the one- the path for this process where the Android gallery and the week study period, the caregiver will attempt to engage the Android music is browsed for the multimedia selection. participant with the multimedia app and then rate the experience using a brief self-report questionnaire. At clinical 5. Discussion study exit, caregivers will repeat the validated self-report questionnaires and complete a feedback interview. The goal Persons with mild to moderate AD who experience BPSD of the feedback interview is to break down the user experi- often require frequent supervision and monitoring, posing ence and solicit likes and dislikes and attitudes about the several challenges to their caregivers. The stress process multimedia app solution. model identifies BPSD as the greatest source of stress on The algorithm for this study is shown in Figure 11, caregivers, with sleep disturbance, agitation/restlessness, where the application starts with a welcome screen and depression, and apathy causing the most emotional dis- the user/caregiver has the option of either creating a tress. We are proposing a multisensor mobile multimedia new patient or selecting a patient that has been registered solution, a technical version of the traditional reminiscence in the past. Next, the user is taken to a menu where the happy therapy to address BPSD, especially for the rural AD pop- memory presentation can be created or a previously created ulation. Rural areas have a proportionally larger elderly 8 Journal of Healthcare Engineering irrespective of the stage in AD, all affected people are able population (14.6% of the rural population is 65 and above versus 11.7% of urban population) and hence a larger to respond and react to musical stimulation in improving number of individuals affected with dementia and fewer cognition, behavior, and mood in AD [18]. Research has health and social services [29–32]. shown individualized music therapy is the most effective After completion of phase 2, descriptive statistics (means, [19]. Our proposal creates an individualized multisensory standard deviation, and frequencies) will be used to describe mobile multimedia environment that is tied to a specific the sample characteristics, total scores, and/or the item-level memory event. results of the clinical tests, validated survey instruments (NPI; RMBC), and the caregiver ratings of BPSD symptoms Conflicts of Interest and caregiver distress after engaging with the multimedia app. For instruments that are administered at study entry The authors declare that they have no conflicts of interest. and exit, we will compare each instrument’s total score at the beginning and the end of the one-week period using References dependent t-tests with false discovery rate correction for the number of variables. To examine feasibility of deploying the [1] Help End Alzheimer’s, Alzheimer's Association, 2017, N.p., n.d. app preloaded on tablets in participants’ homes for use over Web. one-week, we will track and report the following data: (1) [2] J. Cerejeira, L. Lagarto, and E. Mukaetova-Ladinska, “Behav- the percentage of participants who were unable or unwilling ioral and psychological symptoms of dementia,” Frontiers in to multimedia app; (2) the number and type of technical or Neurology, vol. 3, p. 73, 2012. other problems with the multimedia app reported by partic- [3] G. M. Savva, J. Zaccai, F. E. Matthews, J. E. Davidson, ipants; and (3) the number of phone calls and/or unantici- I. McKeith, and Of behalf of the Medical Research Council Cognitive Function and Ageing Study, “Prevalence, correlates pated home visits required by research staff to troubleshoot and course of behavioural and psychological symptoms of problems with the multimedia app. Study personnel will doc- dementia in the population,” The British Journal of Psychiatry, ument any problems reported by participants. If participants vol. 194, no. 03, pp. 212–219, 2009. are unable or unwilling to complete the in-home study after [4] S. B. Michal, P. Werner, M. Davidson, and S. Noy, “The consenting, we will examine whether there are differences cost of behavioral and psychological symptoms of dementia in demographic variables (e.g., age, education, and ethnicity) (BPSD) in community dwelling Alzheimer’s disease patients,” or global cognition (total MoCA score) between study International Journal of Geriatric Psychiatry, vol. 17, no. 5, completers and noncompleters using independent t-tests pp. 403–408, 2002. for continuous variables and the Pearson chi-square test for [5] A. Burns, J. Byrne, C. Ballard, and C. Holmes, “Sensory stimu- categorical variables. lation in dementia: an effective option for managing behav- The long-term goal of this research is to develop a mobile ioural problems,” British Medical Journal, vol. 325, no. 7376, solution to (a) reduce the frequency of BPSD symptoms, (b) pp. 1312-1313, 2002. help recall episodic memory, (c) reduce caregiver burden, [6] R. Howard, C. Ballard, J. O'Brien, A. Burns, and on behalf of and (4) delay nursing home placement. the UK and Ireland Group for Optimization of Management in Dementia, “Guidelines for the management of agitation in dementia,” International Journal of Geriatric Psychiatry, 6. Conclusions vol. 16, no. 7, pp. 714–717, 2001. Our interdisciplinary team of computer scientists and a clin- [7] D. J. Hart, D. Craig, S. A. Compton et al., “A retrospective study of the behavioural and psychological symptoms of mid ical neuropsychologist are working together on developing a and late phase Alzheimer’s disease,” International Journal of tool to help individuals affected with AD and their caregivers Geriatric Psychiatry, vol. 18, no. 11, pp. 1037–1042, 2003. cope with behavioral and psychological symptoms of demen- [8] K. Yaffe, P. Fox, R. Newcomer et al., “Patient and caregiver tia. The application is designed to help calm individuals with characteristics and nursing home placement in patients with AD by jogging old episodic memories and bringing back dementia,” JAMA, vol. 287, no. 16, pp. 2090–2097, 2002. memories of happy times. [9] E. B. Fauth and A. Gibbons, “Which behavioral and psy- This proposal is built by combining the foundational chological symptoms of dementia are the most problematic? concepts of the reminiscence therapy along with the Variability by prevalence, intensity, distress ratings, and concept of music research conducted by Dr. Oliver Sack. associations with caregiver depressive symptoms,” Interna- Reminiscence therapy has been successfully implemented tional Journal of Geriatric Psychiatry, vol. 29, no. 3, pp. 263– to recall past memorable episodic events using prompts 271, 2014. and cues such as photos, in group settings where a group [10] L. I. Pearlin, J. T. Mullan, S. J. Semple, and M. M. Skaff, “Care- leader would lead the session with other friends and family giving and the stress process: an overview of concepts and their of the affected individual and the event is gently reminded measures,” The Gerontologist, vol. 30, no. 5, pp. 583–594, 1990. with cues from a past episodic event. We have created a [11] https://www.census.gov/newsroom/press-releases/2016/cb16- technical version of the reminiscence therapy in the form 210.html. of a mobile application that is built for the Android plat- [12] C. Brems, M. E. Johnson, T. D. Warner, and L. W. Roberts, form. Dr. Oliver Sack, a neurologist, has promoted music “Barriers to healthcare as reported by rural and urban inter- as a powerful tool to stimulate and recall deeply embedded professional providers,” Journal of Interprofessional Care, memory [16–20]. His research has demonstrated that vol. 20, no. 2, pp. 105–118, 2006. Journal of Healthcare Engineering 9 [31] National Advisory Committee on Rural Health & Human [13] D. S. Puskin, “Opportunities and challenges to telemedicine in rural America,” Journal of Medical Systems, vol. 19, no. 1, Services, “The 2010 report to the secretary: rural health pp. 59–67, 1995. and human service issues,” 2008, https://www.hrsa.gov/ advisorycommittees/rural/2010secretaryreport.pdf. [14] A. Raglio, G. Bellelli, D. Traficante et al., “Efficacy of music therapy in the treatment of behavioral and psychiatric symp- [32] M. Ganguli, H. H. Dodge, P. Chen, S. Belle, and S. T. DeKosky, toms of dementia,” Alzheimer Disease & Associated Disorders, “Ten-year incidence of dementia in a rural elderly US commu- vol. 22, no. 2, pp. 158–162, 2008. nity population the MoVIES project,” Neurology, vol. 54, no. 5, pp. 1109–1116, 2000. [15] M. Cotelli, R. Manenti, and O. Zanetti, “Reminiscence therapy in dementia: a review,” Maturitas, vol. 72, no. 3, pp. 203–205, [16] O. Sacks, Musicophilia: Tales of Music and the Brain, Vintage Books, NY, USA, 2008. [17] O. Sacks, Musicophilia – Alzheimer’s/the Power Of Music, 2016, YouTube. N. p., 2016. Web. [18] J. Olazarán, B. Reisberg, L. Clare et al., “Nonpharmacological therapies in Alzheimer’s disease: a systematic review of effi- cacy,” Dementia and Geriatric Cognitive Disorders, vol. 30, no. 2, pp. 161–178, 2010. [19] A. A. Clair and B. Bernstein, “A preliminary study of music therapy programming for severely regressed persons with Alzheimer’s-type dementia,” Journal of Applied Gerontology, vol. 9, no. 3, pp. 299–311, 1990. [20] E. Tulving, “Episodic memory: from mind to brain,” Annual Review of Psychology, vol. 53, no. 1, pp. 1–25, 2002. [21] P. Topo, “Technology studies to meet the needs of people with dementia and their caregivers: a literature review,” Journal of Applied Gerontology, vol. 28, no. 1, pp. 5–37, 2009. [22] A. J. Bharucha, V. Anand, J. Forlizzi et al., “Intelligent assis- tive technology applications to dementia care: current capa- bilities, limitations, and future challenges,” The American Journal of Geriatric Psychiatry, vol. 17, no. 2, pp. 88–104, [23] W. Carswell, P. J. McCullagh, J. C. Augusto et al., “A review of the role of assistive technology for people with dementia in the hours of darkness,” Technology and Health Care, vol. 17, no. 4, pp. 281–304, 2009. [24] S. Cahill, J. Macijauskiene, A. M. Nygård, J. P. Faulkner, and I. Hagen, “Technology in dementia care,” Technology and Disability, vol. 19, pp. 55–60, 2007. [25] P. Topo, O. Mäki, K. Saarikalle et al., “Assessment of a music- based multimedia program for people with dementia,” Demen- tia, vol. 3, no. 3, pp. 331–350, 2004. [26] “Snoezelen multi-sensory environments | sensory rooms and therapy explained,” February 2017, http://Snoezelen.info. N. p., 2017. Web. 10. [27] H. Kaplan, M. Cloptona, M. Kaplanb, L. Messbauera, and K. Mc Phersona, “Snoezelen multi-sensory environments: task engagement and generalization,” Research in Developmental Disabilities, vol. 27, no. 4, pp. 443–455, 2006. [28] J. C. C. Chung and C. K. Y. Lai, “Snoezelen for dementia,” Cochrane Database of Systematic Reviews, no. 4, article CD003152, 2002. [29] F. Sun, J. I. Kosberg, A. V. Kaufman, and J. D. Leeper, “Coping strategies and caregiving outcomes among rural dementia caregivers,” Journal of Gerontological Social Work, vol. 53, no. 6, pp. 547–567, 2010. [30] D. Morgan, A. Innes, and J. Kosteniuk, “Dementia care in rural and remote settings: a systematic review of formal or paid care,” Maturitas, vol. 68, no. 1, pp. 17–33, 2011. International Journal of Advances in Rotating Machinery Multimedia Journal of The Scientific Journal of Engineering World Journal Sensors Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Control Science and Engineering Advances in Civil Engineering Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com Journal of Journal of Electrical and Computer Robotics Engineering Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 VLSI Design Advances in OptoElectronics International Journal of Modelling & Aerospace International Journal of Simulation Navigation and in Engineering Engineering Observation Hindawi Hindawi Hindawi Hindawi Volume 2018 Volume 2018 Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com www.hindawi.com www.hindawi.com Volume 2018 International Journal of Active and Passive International Journal of Antennas and Advances in Chemical Engineering Propagation Electronic Components Shock and Vibration Acoustics and Vibration Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Healthcare Engineering Hindawi Publishing Corporation

A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer’s

Loading next page...
 
/lp/hindawi-publishing-corporation/a-mobile-multimedia-reminiscence-therapy-application-to-reduce-uJ02oaMZ9G

References (35)

Publisher
Hindawi Publishing Corporation
Copyright
Copyright © 2018 Danish Imtiaz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2040-2295
eISSN
2040-2309
DOI
10.1155/2018/1536316
Publisher site
See Article on Publisher Site

Abstract

Hindawi Journal of Healthcare Engineering Volume 2018, Article ID 1536316, 9 pages https://doi.org/10.1155/2018/1536316 Research Article A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer’s 1 2 3,4 Danish Imtiaz, Arshia Khan , and Adriana Seelye George Washington Medical School, Washington, DC, USA Computer Science Department, University of Minnesota Duluth, Duluth, MN, USA University of Minnesota Twin Cities, Minneapolis, MN, USA Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA Correspondence should be addressed to Arshia Khan; akhan@d.umn.edu Received 4 August 2017; Accepted 2 January 2018; Published 21 March 2018 Academic Editor: Denise Ferebee Copyright © 2018 Danish Imtiaz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer’s. BPSD can include agitation, restlessness, aggression, apathy, obsessive-compulsive and repetitive behaviors, hallucinations, delusions, paranoia, and wandering. Alzheimer’s currently affects 5.4 million adults in the United States and that number is projected to increase to 14 million by 2050. Almost 90% of all affected with AD experience BPSD, resulting in increased healthcare costs, heavier burden on caregivers, poor patient outcomes, early nursing home placement, long-term hospitalizations, and misuse of medications. Pharmacological support may have undesirable side effects such as sedation. Nonpharmacological interventions are alternative solutions that have shown to be effective without undesirable side effects. Music therapy has been found to lower BPSD symptoms significantly. Our study is based on combination of the reminiscence and the music therapies where past memorable events are recalled using prompts such as photos, videos, and music. We are proposing a mobile multimedia solution, a technical version of the combined reminiscence, and music therapies to prevent the occurrence of BPSD, especially for the rural population who have reduced access to dementia care services. 1. Introduction need for caregiver also increases. More than 15 million family and friends of affected people provide care for the person Approximately 35.6 million people worldwide and more affected with AD. In 2016, over $236 billion dollars were than 5 million in the United States suffer from dementia. spent on dementia [1]. Indirect cost increase due to BPSD Every 66 seconds, a person in the United States develops in person affected with AD was 25% above the cost of AD, dementia [1]. Almost 90% of all affected with Alzheimer’s while the direct costs increase was 35% above the direct AD disease (AD) experience behavioral and psychological symp- costs [4]. toms of dementia (BPSD), resulting in increased healthcare As the disease progresses, many affected individuals costs, heavier burden on caregivers, poor patient outcomes, develop psychological problems in the form of behavior early nursing home placement, long-term hospitalizations, issues such as agitation, irritability, aggression, depression, and misuse of medications [2]. BPSD play a major role in delusions and hallucinations, wandering, and sleep disorders [5–7]. Among behavioral symptoms, approximately 88% of increasing burden on the caregivers of individuals affected with dementia [3]. BPSD is not only a contributor to care- the patients suffer from apathy, 66% suffer from aggression, giver distress but also a major cause for nursing home place- and 60% suffer from irritability, while among psychological ment [4]. As the number of affected people increases, the symptoms, 56% of patients suffer from depression, 55% 2 Journal of Healthcare Engineering suffer from delusions, and 52% suffer from anxiety. In one study, not only were behavioral symptoms found to be more prevalent, but these symptoms were also more stressful to caregivers than the psychological symptoms [7]. If these symptoms are not treated, they can reduce the quality of life, expedite functional decline, and cause early transfer to assisted living [1, 7, 8]. Of these symptoms, the most preva- lent and distressing were behavioral symptoms such as agita- tion, irritability, and apathy [9]. The stress process model identifies BPSD as the greatest source of stress on caregivers [10]. Persons with mild to moderate AD who are affected with BPSD often require frequent supervision, monitoring, and support. This poses several challenges, especially in rural parts of the country due to limitations in resources. Approx- imately 30% of the total costs for AD are from BPSD man- agement [4]. As per the US census of 2010, approximately 19.3% of the US population resides in rural areas that covers 97% of the land [11]. Due to the large distances between the rural communities, the residents in rural areas are faced with greater health care barriers than their urban counterparts. Some of the barriers experienced by the residents in rural areas are constrained access to care, limited resource avail- ability, overlapping clinician roles, long distance provider commute, and clinician training constraints [12]. Rural resi- dents face problems of not only scarcity of primary care pro- viders but also long distances between care providers and the rural communities [13]. In addition, rural areas have a pro- portionally larger elderly population (14.6% of the rural pop- Figure 1: Welcome page. ulation is 65 and above versus 11.7% of urban population) and hence a larger number of individuals affected with dementia and fewer health and social services. The goal of using prompts such as photos and music in group settings this project is to create a calming and relaxing effect while where a group leader would lead the session with other helping resurface embedded event memory in persons with friends and family of the affected individual and the event is gently reminded with cues from the event. Although tradi- AD by tackling distressing BPSD symptoms. Pharmacologi- cal support in the form of antipsychotic drugs can be used, tional reminiscence therapy has proved to help lower BPSD but these are not always helpful and may have side effects symptoms notably, it is not only time and resource intensive; such as sedation. Nonpharmacological solutions such as it is typically conducted in a group setting and requires reminiscence therapy and music therapy are encouraged in resources such as a trained group leader. We are proposing a variation of the reminiscence therapy where the group addressing BPSD. Music therapy has proved to lower BPSD in persons leader and the other family members are not required to be affected with dementia. In one study, music therapy was present each time the therapy is performed. Dr. Oliver Sack, applied for 16 weeks and subjects were evaluated by multidi- a neurologist, has promoted music as a powerful tool to stim- mensional assessment including minimental state examina- ulate and recall deeply embedded memory [16–20]. Irrespec- tion, Barthel index, and neuropsychiatry inventory. These tive of their stage in AD, all people are able to respond and subjects were observed to have a significant decrease in the react to musical stimulation in improving cognition, behav- NPI score, and the symptoms of agitation, irritation, apathy, ior, and mood in AD [18]. Research has shown individual- delusions, and hallucinations were greatly reduced [14]. ized music therapy is the most effective [19]. Our proposal Reminiscence therapy has been successfully used to help creates an individualized multisensory mobile multimedia address BPSD [15]. However, traditional reminiscence ther- environment that is tied to a specific memory event as seen apy is time consuming, which makes it difficult to imple- in Figures 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10. ment, especially in a rural setting. Additionally, this type of therapy is conducted in a group setting and requires 2. Related Work resources such as a trained group leader and other members who are skilled to work in this group. These resources are Technology has been proposed as a means of treating many often not available to community-dwelling older adults who facets of dementia, including challenging behaviors such as live in rural areas. anxiety, restlessness, agitation, sleep disturbances, and disori- Our proposal is based on two foundational concepts—re- entation, especially in regard to time and place and physical miniscence therapy and Dr. Oliver Sack’s music research. functioning [21, 22]. As can be seen, the scope of these tech- Reminiscence therapy is used to recall past memorable events nological innovations varies greatly. In addition to the scope, Journal of Healthcare Engineering 3 Figure 2: Patient information. Figure 4: Menu selection. Figure 3: Select patient. Figure 5: Media selection. 4 Journal of Healthcare Engineering Figure 6: Music source. Figure 8: Photo source. Figure 7: Music selection. Figure 9: Photo selection. Journal of Healthcare Engineering 5 Snoezelen, is a multisensory environment that seeks to reduce agitation and anxiety or stimulate reactions of com- munication in patients by creating a very engaging yet con- trolled environment. Snoezelen has been used to reduce challenging behavior among individuals affected with AD [26, 27]. Various studies have shown improvement in mood, behavior, and cognition after treatments. Patients’ communi- cation improved during the Snoezelen sessions, and patients showed improvements in both short- and long-term follow- up evaluations [28]. These studies illustrate the impact technology can have on management of BPSD and improv- ing the lives of those with dementia and their caregivers. The picture gramophone, a word processing solution, was a music-based multimedia tool that was developed in the 1990s to help improve the well-being in persons with dementia and displayed promising results [25]. Current technological solutions and support applications for caregivers do not address BPSD directly. The objective of our multimedia application is to stimulate deeply embedded memories by recreating events through use of music, images, and textual descriptions, for example, incorporating pictures of important events such as a wedding or birthday into a slideshow to reduce BPSD in persons with Alzheimer’s dis- ease. The objective of our project is to address BPSD in per- sons with AD by stimulating deeply embedded memories by recreating events through use of meaningful music and Figure 10: Photo display time. personalized images and textual descriptions. For example, we will incorporate pictures of important events such as a wedding or birthday into a slideshow that can calm the the approach utilized by these applications differs signifi- cantly. Among the investigated applications are care-team affected individual. communication tools, electronic encyclopedias, decision support applications for at-home caregivers, Internet-based 3. Framework support groups, home monitoring systems, human-to- human interaction tools, computer-based memory tools, We are proposing a framework to address BPSD in dementia audio and video tapes, and entertainment [21–24]. Of all such as agitation, irritability, and apathy by combining ther- the related technological innovations, two stood out as apies such as reminiscence and music therapies into a tech- strongly related to the proposed application. The first, devel- nological, affordable, personalized, and accessible mobile oped by a research team made up of professionals from the solution to reduce BPSD and their associated stress on care- National Research and Development Centre for Welfare givers. The uniqueness of this proposal is the design with and Health from Finland, Dementia Services Information respect to accessibility and affordability of a mobile applica- and Development Centre from Dublin, the Norwegian Cen- tion and the individualized nature of the music and reminis- tre for Dementia Research, and Dementia Voice from the cence therapy components. The caregiver can pick an United Kingdom evaluated the effectiveness of a music- important event in the life of the affected individual and based and multimedia program in dementia care centers in use cues, such as pictures, videos, and music, associated with the four represented countries with the primary aim of stim- that event. Cues help jog deeply embedded memories related ulating patients and to give them pleasure. This was a word to an event; for example, incorporating pictures of important processing editor called the picture gramophone and events such as a wedding or birthday into a slideshow can designed for a desktop with a CD drive, a keyboard, and a help the affected individual to calm down. Reminiscence mouse. Results showed that 91% of participants showed therapy and music therapies have proved to be very beneficial some form of benefit from the tool, in either mood or social in addressing BPSD and have been recommended to reduce interaction [25]. The application design varied from our BPSD. We are combining the concept of using prompts such proposed solution in that it was specialized to the region as objects and people in helping recall episodic-embedded and minimally modified to the individual but in no way memory from reminiscence therapy and the concept of individualized to the particular patient or events in that music helping in memory recall in persons affected with patient’s life, although the authors noted that this should AD as promoted by neurologist, Dr. Oliver Sack. We are pro- be a consideration for future developments. In addition, posing to incorporate the positive aspects of reminiscence because of logistics, this technology was available to patients and music therapies into a user-friendly mobile application only at the care center. Finally, some patients needed sup- that is affordable and easily accessible to caregivers and per- port when working with the tool. The second application, sons with AD. Pharmacological solutions are not encouraged 6 Journal of Healthcare Engineering Hypothesis: After engaging with the reminiscence ther- due to the undesirable side effects of sedation. Our proposal is a low-cost solution to address BPSD and help support care- apy app during an episode of BPSD, there will be a reduction givers. The mobile app will be designed for multiple mobile in neuropsychiatric symptoms as evidenced by caregiver- platforms such as iOS and Android. The challenges in this report ratings on a semistructured questionnaire. There will application will be the ability to select music/video/pictures be an overall reduction in neuropsychiatric symptoms over from the mobile user’s music playlist/photo/video library, the one-week period as evidenced by lower scores on vali- or if there is no music associated with this particular event, dated caregiver-report questionnaires assessing BPSD such and then performing a search to find music of the era of as the neuropsychiatric inventory (NPI; Cummings, 1994) and the revised memory and behavior checklist (RMBC; the same timeframe as the event for which the multisensory multimedia event is being created. Another challenge will Terri, 1992). be to design the user interface in a way that is user-friendly and accessible to the caregiver, who will most likely be an 4.2. Phase 2/Aim 2. Design a multisensory mobile appli- older adult and who may or may not have much computer cation that engages the person with AD and reduces caregiver burden. or smartphone experience. Also, it will be important to make the music/picture selection process a quick one, as caregivers Hypothesis: After engaging with the reminiscence ther- will likely want to address BPSD symptoms quickly once they apy app during an episode of BPSD, there will be a reduction occur. The caregiver will decide on an event such as a wed- in caregiver distress as evidenced by caregiver self-report rat- ding and find pictures, videos, and music-associated with this ings on a semistructured questionnaire. There will be an overall reduction in caregiver distress over the one-week event. These will be incorporated into a multimedia slide- show and played to the affected individual when he/she is period as evidenced by lower scores on validated self-report agitated, irritated or experiences apathy. questionnaires assessing BPSD-related caregiver distress such as the NPI and the RMBC. The mobile application is built for the Android plat- 4. Methods and Design form and is designed to be user-friendly so a caregiver can easily set up a patient and create the multimedia epi- In this two-phase exploratory study, a multisensory sodic happy memory event-based presentations for the multimedia-based mobile application has been developed for the Android mobile platform as seen in Figures 1, 2, 3, patients. Figure 1 shows the welcome page of the applica- tion when it firsts starts; Figure 2 gives user the option of 4, 5, 6, 7, 8, 9, and 10 for phase 1, while the clinical study will entering the information for a new patient as this applica- be conducted in phase 2. Only phase 1 will be described in this paper. Phase 1 will comprise of designing and building tion can be used for multiple individuals affected with AD; Figure 3 shows the screen where an existing patient can be the mobile application for multiple platforms, and phase 2 will comprise of the clinical study. The objective of phase 2 selected from a database of patients; Figure 4 shows where the caregiver has the choice of either choosing to create a new of the project is to stimulate deeply embedded event-based happy memory multimedia presentation or selecting from a episodic memories of persons affected with AD. The care- giver will pick an important memorable event from the life list of happy memories that were created in the past; the happy memory events created are unique to each patient of the affected individual and use cues, such as pictures and music, associated with that event to create a multisensory with their photos and music. Hence, this application can be customized to each individual’s needs making unique set multimedia show paired with music that was either from of episodic happy memories. Figure 5 shows the first screen the event or associated with the event. If there is no music associated with this event, then the application will find that appears when the caregiver chooses to create a new happy memory presentation, where the caregiver has a music of that period to create this multimedia show. The videos or photos will serve as prompts and cues to help jog choice of either selecting pictures for the new happy memory or music for this new presentation since various pictures and deeply embedded memories related to this event. An example or videos can be incorporated in the multisensory multime- of creating a multisensory multimedia show is selecting pictures and videos of important events such as a wedding dia event-based presentation. Figure 6 shows how the caregiver can select between or birthday into a slideshow that can help the affected indi- vidual to calm down. This calming effect potentially helps music databases to add music associated with this happy memory. Figure 7 shows the screen where the caregiver can the affected individual recall associated memories. The pro- select the music from the music library. Figure 8 shows the ject will be executed in two phases. The design is built on the following research question and hypotheses. screen for the photo selection while Figure 9 shows where the images/photos are selected. Finally, Figure 10 shows Research question: Can a multisensory mobile multime- dia reminiscence therapy app reduce the frequency of BPSD how the user can select the length of time of display for the images/photos. episodes by helping calm and reducing agitation, irritation, At clinical study (phase 2) entry, caregivers will com- and apathy by recreating an event/episodic memory in per- sons with AD? plete validated self-report measures assessing BPSD in their AD person over the past week and BPSD-related caregiver 4.1. Phase 1/Aim 1. Design a multisensory mobile application distress. Caregivers will provide study staff with pictures, that employs reminiscence therapy to reduce the frequency movies, music, and any other media that is meaningful to the AD participant’s past to be loaded on the multimedia of BPSD episodes in persons with AD. Journal of Healthcare Engineering 7 New user Entry point Welcome newUser() returningUser() Patient information Enter patient information saveInfo() Menu create() viewPrevious() Create multimedia View created show multimedia shows loadImgGallery() Android gallery Select images onActivityResult() Set image details Select multimedia (time/order) show to view loadSong() viewMultimediaShow() viewAnother() Select songs Android music onActivityResult() Set song details View it (time/order) viewMultimediaShow() Figure 11: Algorithm for the Happy Times Android application. app. After the media has been loaded on the study tablet, happy memory event presentation can be viewed. The user participants will be given the tablet equipped with the mul- then has a choice between selecting music or photos that timedia application to use in their home for one week. Any can be added to the happy memory. The algorithm shows time the AD participant experiences BPSD during the one- the path for this process where the Android gallery and the week study period, the caregiver will attempt to engage the Android music is browsed for the multimedia selection. participant with the multimedia app and then rate the experience using a brief self-report questionnaire. At clinical 5. Discussion study exit, caregivers will repeat the validated self-report questionnaires and complete a feedback interview. The goal Persons with mild to moderate AD who experience BPSD of the feedback interview is to break down the user experi- often require frequent supervision and monitoring, posing ence and solicit likes and dislikes and attitudes about the several challenges to their caregivers. The stress process multimedia app solution. model identifies BPSD as the greatest source of stress on The algorithm for this study is shown in Figure 11, caregivers, with sleep disturbance, agitation/restlessness, where the application starts with a welcome screen and depression, and apathy causing the most emotional dis- the user/caregiver has the option of either creating a tress. We are proposing a multisensor mobile multimedia new patient or selecting a patient that has been registered solution, a technical version of the traditional reminiscence in the past. Next, the user is taken to a menu where the happy therapy to address BPSD, especially for the rural AD pop- memory presentation can be created or a previously created ulation. Rural areas have a proportionally larger elderly 8 Journal of Healthcare Engineering irrespective of the stage in AD, all affected people are able population (14.6% of the rural population is 65 and above versus 11.7% of urban population) and hence a larger to respond and react to musical stimulation in improving number of individuals affected with dementia and fewer cognition, behavior, and mood in AD [18]. Research has health and social services [29–32]. shown individualized music therapy is the most effective After completion of phase 2, descriptive statistics (means, [19]. Our proposal creates an individualized multisensory standard deviation, and frequencies) will be used to describe mobile multimedia environment that is tied to a specific the sample characteristics, total scores, and/or the item-level memory event. results of the clinical tests, validated survey instruments (NPI; RMBC), and the caregiver ratings of BPSD symptoms Conflicts of Interest and caregiver distress after engaging with the multimedia app. For instruments that are administered at study entry The authors declare that they have no conflicts of interest. and exit, we will compare each instrument’s total score at the beginning and the end of the one-week period using References dependent t-tests with false discovery rate correction for the number of variables. To examine feasibility of deploying the [1] Help End Alzheimer’s, Alzheimer's Association, 2017, N.p., n.d. app preloaded on tablets in participants’ homes for use over Web. one-week, we will track and report the following data: (1) [2] J. Cerejeira, L. Lagarto, and E. Mukaetova-Ladinska, “Behav- the percentage of participants who were unable or unwilling ioral and psychological symptoms of dementia,” Frontiers in to multimedia app; (2) the number and type of technical or Neurology, vol. 3, p. 73, 2012. other problems with the multimedia app reported by partic- [3] G. M. Savva, J. Zaccai, F. E. Matthews, J. E. Davidson, ipants; and (3) the number of phone calls and/or unantici- I. McKeith, and Of behalf of the Medical Research Council Cognitive Function and Ageing Study, “Prevalence, correlates pated home visits required by research staff to troubleshoot and course of behavioural and psychological symptoms of problems with the multimedia app. Study personnel will doc- dementia in the population,” The British Journal of Psychiatry, ument any problems reported by participants. If participants vol. 194, no. 03, pp. 212–219, 2009. are unable or unwilling to complete the in-home study after [4] S. B. Michal, P. Werner, M. Davidson, and S. Noy, “The consenting, we will examine whether there are differences cost of behavioral and psychological symptoms of dementia in demographic variables (e.g., age, education, and ethnicity) (BPSD) in community dwelling Alzheimer’s disease patients,” or global cognition (total MoCA score) between study International Journal of Geriatric Psychiatry, vol. 17, no. 5, completers and noncompleters using independent t-tests pp. 403–408, 2002. for continuous variables and the Pearson chi-square test for [5] A. Burns, J. Byrne, C. Ballard, and C. Holmes, “Sensory stimu- categorical variables. lation in dementia: an effective option for managing behav- The long-term goal of this research is to develop a mobile ioural problems,” British Medical Journal, vol. 325, no. 7376, solution to (a) reduce the frequency of BPSD symptoms, (b) pp. 1312-1313, 2002. help recall episodic memory, (c) reduce caregiver burden, [6] R. Howard, C. Ballard, J. O'Brien, A. Burns, and on behalf of and (4) delay nursing home placement. the UK and Ireland Group for Optimization of Management in Dementia, “Guidelines for the management of agitation in dementia,” International Journal of Geriatric Psychiatry, 6. Conclusions vol. 16, no. 7, pp. 714–717, 2001. Our interdisciplinary team of computer scientists and a clin- [7] D. J. Hart, D. Craig, S. A. Compton et al., “A retrospective study of the behavioural and psychological symptoms of mid ical neuropsychologist are working together on developing a and late phase Alzheimer’s disease,” International Journal of tool to help individuals affected with AD and their caregivers Geriatric Psychiatry, vol. 18, no. 11, pp. 1037–1042, 2003. cope with behavioral and psychological symptoms of demen- [8] K. Yaffe, P. Fox, R. Newcomer et al., “Patient and caregiver tia. The application is designed to help calm individuals with characteristics and nursing home placement in patients with AD by jogging old episodic memories and bringing back dementia,” JAMA, vol. 287, no. 16, pp. 2090–2097, 2002. memories of happy times. [9] E. B. Fauth and A. Gibbons, “Which behavioral and psy- This proposal is built by combining the foundational chological symptoms of dementia are the most problematic? concepts of the reminiscence therapy along with the Variability by prevalence, intensity, distress ratings, and concept of music research conducted by Dr. Oliver Sack. associations with caregiver depressive symptoms,” Interna- Reminiscence therapy has been successfully implemented tional Journal of Geriatric Psychiatry, vol. 29, no. 3, pp. 263– to recall past memorable episodic events using prompts 271, 2014. and cues such as photos, in group settings where a group [10] L. I. Pearlin, J. T. Mullan, S. J. Semple, and M. M. Skaff, “Care- leader would lead the session with other friends and family giving and the stress process: an overview of concepts and their of the affected individual and the event is gently reminded measures,” The Gerontologist, vol. 30, no. 5, pp. 583–594, 1990. with cues from a past episodic event. We have created a [11] https://www.census.gov/newsroom/press-releases/2016/cb16- technical version of the reminiscence therapy in the form 210.html. of a mobile application that is built for the Android plat- [12] C. Brems, M. E. Johnson, T. D. Warner, and L. W. Roberts, form. Dr. Oliver Sack, a neurologist, has promoted music “Barriers to healthcare as reported by rural and urban inter- as a powerful tool to stimulate and recall deeply embedded professional providers,” Journal of Interprofessional Care, memory [16–20]. His research has demonstrated that vol. 20, no. 2, pp. 105–118, 2006. Journal of Healthcare Engineering 9 [31] National Advisory Committee on Rural Health & Human [13] D. S. Puskin, “Opportunities and challenges to telemedicine in rural America,” Journal of Medical Systems, vol. 19, no. 1, Services, “The 2010 report to the secretary: rural health pp. 59–67, 1995. and human service issues,” 2008, https://www.hrsa.gov/ advisorycommittees/rural/2010secretaryreport.pdf. [14] A. Raglio, G. Bellelli, D. Traficante et al., “Efficacy of music therapy in the treatment of behavioral and psychiatric symp- [32] M. Ganguli, H. H. Dodge, P. Chen, S. Belle, and S. T. DeKosky, toms of dementia,” Alzheimer Disease & Associated Disorders, “Ten-year incidence of dementia in a rural elderly US commu- vol. 22, no. 2, pp. 158–162, 2008. nity population the MoVIES project,” Neurology, vol. 54, no. 5, pp. 1109–1116, 2000. [15] M. Cotelli, R. Manenti, and O. Zanetti, “Reminiscence therapy in dementia: a review,” Maturitas, vol. 72, no. 3, pp. 203–205, [16] O. Sacks, Musicophilia: Tales of Music and the Brain, Vintage Books, NY, USA, 2008. [17] O. Sacks, Musicophilia – Alzheimer’s/the Power Of Music, 2016, YouTube. N. p., 2016. Web. [18] J. Olazarán, B. Reisberg, L. Clare et al., “Nonpharmacological therapies in Alzheimer’s disease: a systematic review of effi- cacy,” Dementia and Geriatric Cognitive Disorders, vol. 30, no. 2, pp. 161–178, 2010. [19] A. A. Clair and B. Bernstein, “A preliminary study of music therapy programming for severely regressed persons with Alzheimer’s-type dementia,” Journal of Applied Gerontology, vol. 9, no. 3, pp. 299–311, 1990. [20] E. Tulving, “Episodic memory: from mind to brain,” Annual Review of Psychology, vol. 53, no. 1, pp. 1–25, 2002. [21] P. Topo, “Technology studies to meet the needs of people with dementia and their caregivers: a literature review,” Journal of Applied Gerontology, vol. 28, no. 1, pp. 5–37, 2009. [22] A. J. Bharucha, V. Anand, J. Forlizzi et al., “Intelligent assis- tive technology applications to dementia care: current capa- bilities, limitations, and future challenges,” The American Journal of Geriatric Psychiatry, vol. 17, no. 2, pp. 88–104, [23] W. Carswell, P. J. McCullagh, J. C. Augusto et al., “A review of the role of assistive technology for people with dementia in the hours of darkness,” Technology and Health Care, vol. 17, no. 4, pp. 281–304, 2009. [24] S. Cahill, J. Macijauskiene, A. M. Nygård, J. P. Faulkner, and I. Hagen, “Technology in dementia care,” Technology and Disability, vol. 19, pp. 55–60, 2007. [25] P. Topo, O. Mäki, K. Saarikalle et al., “Assessment of a music- based multimedia program for people with dementia,” Demen- tia, vol. 3, no. 3, pp. 331–350, 2004. [26] “Snoezelen multi-sensory environments | sensory rooms and therapy explained,” February 2017, http://Snoezelen.info. N. p., 2017. Web. 10. [27] H. Kaplan, M. Cloptona, M. Kaplanb, L. Messbauera, and K. Mc Phersona, “Snoezelen multi-sensory environments: task engagement and generalization,” Research in Developmental Disabilities, vol. 27, no. 4, pp. 443–455, 2006. [28] J. C. C. Chung and C. K. Y. Lai, “Snoezelen for dementia,” Cochrane Database of Systematic Reviews, no. 4, article CD003152, 2002. [29] F. Sun, J. I. Kosberg, A. V. Kaufman, and J. D. Leeper, “Coping strategies and caregiving outcomes among rural dementia caregivers,” Journal of Gerontological Social Work, vol. 53, no. 6, pp. 547–567, 2010. [30] D. Morgan, A. Innes, and J. Kosteniuk, “Dementia care in rural and remote settings: a systematic review of formal or paid care,” Maturitas, vol. 68, no. 1, pp. 17–33, 2011. International Journal of Advances in Rotating Machinery Multimedia Journal of The Scientific Journal of Engineering World Journal Sensors Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Control Science and Engineering Advances in Civil Engineering Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com Journal of Journal of Electrical and Computer Robotics Engineering Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 VLSI Design Advances in OptoElectronics International Journal of Modelling & Aerospace International Journal of Simulation Navigation and in Engineering Engineering Observation Hindawi Hindawi Hindawi Hindawi Volume 2018 Volume 2018 Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com www.hindawi.com www.hindawi.com Volume 2018 International Journal of Active and Passive International Journal of Antennas and Advances in Chemical Engineering Propagation Electronic Components Shock and Vibration Acoustics and Vibration Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Journal of Healthcare EngineeringHindawi Publishing Corporation

Published: Mar 21, 2018

There are no references for this article.