Naturalistic Assessment of Everyday Activities and Prompting Technologies in Mild Cognitive Impairment

Abstract

Older adults with mild cognitive impairment (MCI) often have difficulty performing complex instrumental activities of daily living (IADLs), which are critical to independent living. In this study, amnestic multi-domain MCI (N = 29), amnestic single-domain MCI (N = 18), and healthy older participants (N = 47) completed eight scripted IADLs (e.g., cook oatmeal on the stove) in a smart apartment testbed. We developed and experimented with a graded hierarchy of technology-based prompts to investigate both the amount of prompting and type of prompts required to assist individuals with MCI in completing the activities. When task errors occurred, progressive levels of assistance were provided, starting with the lowest level needed to adjust performance. Results showed that the multi-domain MCI group made more errors and required more prompts than the single-domain MCI and healthy older adult groups. Similar to the other two groups, the multi-domain MCI group responded well to the indirect prompts and did not need a higher level of prompting to get back on track successfully with the tasks. Need for prompting assistance was best predicted by verbal memory abilities in multi-domain amnestic MCI. Participants across groups indicated that they perceived the prompting technology to be very helpful.

Mild Cognitive Impairment and Changes in Everyday Function Over Time: The Importance of Evaluating Both Speed and Accuracy

“…39 In particular, measures of processing speed have been found to be unique predictors of everyday function directly observed in a naturalistic environment, but not necessarily of performance-based measures or informant report of IADL. 40 Therefore, naturalistic assessment may enhance our understanding of speed and accuracy on everyday activities in individuals with MCI. The results of this study suggest that clinicians and patients may benefit from routine monitoring of speed and accuracy of functional change in older adults and persons with MCI.…”

The Potential Utility of Eye Movements in the Detection and Characterization of Everyday Functional Difficulties in Mild Cognitive Impairment

“…However, the combination of executive and episodic memory impairments in MCI is common (Libon et al 2010), and multi-domain MCI (i.e., multiple cognitive functions impaired) has been associated with greater functional impairment than single-domain MCI (Alexopoulos et al 2006;Aretouli and Brandt 2010;Bombin et al 2012;Seelye et al 2013;Tam et al 2007). Further, a combination of cognitive domains, including episodic memory, semantic ability, executive function, and processing speed/attention, together have been shown to explain the majority of variance in a performance-based measure of functioning (Goldberg et al 2010).…”

A New Approach to the Characterization of Subtle Errors in Everyday Action: Implications for Mild Cognitive Impairment

“…However, the combination of executive and episodic memory impairments in MCI is common (Libon et al, 2010) and has been associated with more severe cognitive and functional impairment (Lopez et al, 2006;Zanetti et al, 2006). Specifically, severity of MCI based on number of impaired domains (i.e., single-vs multi-domain) has been shown to be more important in determining both informant-reported and performance-based functional status than MCI subtype (Aretouli & Brandt, 2010;Seelye, Schmitter-Edgecombe, Cook, & Crandall, 2013). Thus it is important to consider the influence of different cognitive processes along a continuum of functioning, eliminating arbitrary cut-off scores.…”