Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer’s disease in Hong Kong: a pilot study

Abstract

BackgroundImproving the situation in older adults with cognitive decline and evidence of cognitive rehabilitation is considered crucial in long-term care of the elderly. The objective of this study was to implement a computerized errorless learning-based memory training program (CELP) for persons with early Alzheimer’s disease, and to compare the training outcomes of a CELP group with those of a therapist-led errorless learning program (TELP) group and a waiting-list control group.MethodsA randomized controlled trial with a single-blind research design was used in the study. Chinese patients with early Alzheimer’s disease screened by the Clinical Dementia Rating (score of 1) were recruited. The subjects were randomly assigned to CELP (n = 6), TELP (n = 6), and waiting-list control (n = 7) groups. Evaluation of subjects before and after testing, and at three-month follow-up was achieved using primary outcomes on the Chinese Mini-Mental State Examination, Chinese Dementia Rating Scale, Hong Kong List Learning Test, and the Brief Assessment of Prospective Memory-Short Form. Secondary outcomes were the Modified Barthel Index, Hong Kong Lawton Instrumental Activities of Daily Living Scale, and Geriatric Depression Scale-Short Form. The data were analyzed using Friedman’s test for time effect and the Kruskal-Wallis test for treatment effect.ResultsPositive treatment effects on cognition were found in two errorless learning-based memory groups (ie, computer-assisted and therapist-led). Remarkable changes were shown in cognitive function for subjects receiving CELP and emotional/daily functions in those receiving TELP.ConclusionPositive changes in the cognitive function of Chinese patients with early Alzheimer’s disease were initially found after errorless training through CELP. Further enhancement of the training program is recommended.

Recommendations on the Design of Serious Games for People with Dementia

“…Eight studies used a touch screen or a PC keyboard in combination with a PC mouse (20,24,(27)(28)(29)(30)(31)(32). Touch control, keyboard and mouse require fine motor skills on a relative small (Tablet) PC screen.…”

“…Nintendo Wii Bowling ® , which was applied in three studies (22,37,38), provides immediate feedback through showing the player a screen with the fallen pins and with the pins that are still standing. One study explicitly mentioned that their virtual memory program provided immediate audiovisual and positive feedback (24). In MobiAssist, PwD played a quiz game where they had to choose the right out of four given answers.…”

“…To reinforce learning (memory) strategies, providing immediate and positive feedback (e.g. audio or visual signals as mentioned above) is important (24) and could prevent PwD from frustration and the loss of motivation. Adapting feedback to the player's visual and hearing abilities could be done by giving audio feedback for PwD with visual impairment and vice versa.…”

“…Sixteen studies reported that instructions and introductory sessions (explanation of technical equipment and content of SG, and exemplary demonstration of games) were given by the caregiver or research personnel, respectively (20,22,24,(29)(30)(31)(32)(33)(34)(35)(37)(38)(39). Ten studies reported that they provided repeated assistance on technical equipment and (18,20,22,23,27,32,33,(37)(38)(39).…”

“…In yet another study, PwD had to find a certain room or certain targets in a virtual apartment (23). One study applied a game with IADL tasks such as grocery shopping or taking the bus (24).…”