Can assistive technology preserve cognitive function in older adults?

Can assistive technology preserve cognitive function in older adults?

(Shutterstock, 2003-2020)

Cognitive function is defined as “multiple mental abilities, including learning, thinking, reasoning, remembering, problem solving, decision making, and attention” (Pak & Mclaughlin, 2018). Continued cognitive functioning is necessary to the maintenance of a later life that is active, healthy and independent (Baltes, 2019). When there are problems with a major aspect of cognitive function: memory, orientation, perception, attention, problem solving, language and learning, an error in brain functioning or cognitive disability can result.

This blog seeks to answer the question, “Can assistive technology preserve cognitive function in older adults?” I will analyse current theories that correlate cognitive disability or decline with mental illnesses and disabilities of aging, and talk about how these mental illnesses and disabilities affect a key part of cognitive ability, the issue of attention. I will then analyse technologies that claim to improve attention and issues of cognitive function, (including video games, reading pens, app linked devices, and  locator devices) and explain what these technologies mean to older adults with or without mental illness and their caregivers, to come up with a conclusion to this question.

mental health, active and healthy lifestyle senior man lifting up two idea light bulb, from an opened head - old man lifting weights stock illustrations
(iStockphoto, 2020)

Theories

Theories about how why humans experience cognitive decline and theories about how we can prevent cognitive frailties and cognitive decline are important to understand, as age related cognitive disabilities (such as dementia and stroke) are becoming more prevalent in today’s aging society (Movish, 2017).

Connections have been made between aging theory and cognitive functioning. An analysis of a psychological theory of ageing – disengagement theory – assumes that older adults should be allowed to disengage from past roles and pursue roles more fitting to inevitable states of mental decline (Wadensten, 2006). Theory implies that cognitive decline is an expected part of the aging process. This is an issue because the theory could lead to a failure to identify problems associated with cognitive declines that require urgent care (e.g. delirium). The disengagement theory would also suggest that a depressed mood is associated to cognitive decline and that depression is in fact, a factor of aging (Horgan, 2020b). Depression may be the result of mental capacity losses associated with aging (Horgan, 2020b), however, Touhy et al. (2014) proposes that depression is not a part of normal aging, and that if this fact is overlooked, it’s link to dementia and cognitive decline may be overlooked as well.

Another prominent theory, psychodynamic theory, argues that cognitive decline and cognitive changes are part of the aging process. It also suggests that cognitive decline and cognitive changes are tied to personality and changes within the unconscious and conscious mind (Segal et al., 2018, p. 166). The structure of our personality can effect how we think, feel, act and adapt, and overzealous aspects of our personalities (e.g. the id or superego), can cause cognitive changes and emotional dysregulation. This dysregulation can be linked to expressions of this imbalance (e.g. increased impulsivity, Freudian slips) which could be interpreted as expressions of cognitive decline. The psychodynamic paradigm suggests that cognitive changes are instrumental to our personality, and that past experiences are instrumental to the creation of our current selves. Without the balance of our psyche, and memories of our past, the theory suggests that cognition is fractured and that we must repair our memories and cognitive function to repair our personality, our psyche and ourselves (Hagburg, 2013, p. 14). This theory posits a path to repair, as it views cognitive maturity as a key element of cognitive development. It is implied that declining cognition therefore does not allow for this cognitive maturity and personality growth, and that cognitive maturation is needed to avoid personal autonomy, memory, perception and adaptive behaviour limitations (Hagburg, 2013, p. 15).

Less prominent theories also offer insight to prevention of cognitive decline. For example, it is theorized that a larger brain volume and a larger cognitive reserve (greater amounts of brain function) are protective against dementia (Prince et al., 2014). Higher education has also been posited to have protective effects against dementia (a belief based on the theory that individuals with more education develop more complex and efficient neural networks that are able to compensate better to neural damage caused by dementia pathology) (Prince et al., 2014). Finally, there is also a “use it or lose it” theory that suggests that cognitive decline can be prevented with continuous cognitive activity (Prince et al., 2014).

It is important to make the connections between theory and these concepts so that we can better comprehend how assistive technologies can impact cognitive decline, depression, dementia, cognitive decline, mental illness and the aging process simultaneously.

(University of Sussex, 2018).

For example, as you can see within the illustration below, depression is a risk factor, an early sign and a side effect of Alzheimer’s disease; a form of Dementia. Dementia is also a neurological challenge of aging that can effect your mental health, and it can cause mood imbalances that can be detrimental to one’s mental wellbeing  (Segal et al., 2018).

figure1
(Dafsari & Jessen, 2020)

Assistive technologies that improve ones experience with cognitive challenges of depression can hypothetically repair cognitive imbalances that are detrimental to one’s mental wellbeing; according to psychodynamic theory, which also suggests that cognitive challenges are the most significant symptom of Dementia.

A Key Issue of Attention

To simplify assistive technologies role within the repair and prevent cognitive decline, I want to bring up an issue of cognitive function. When technology improves an element of cognitive function (e.g. attention) cognition improves. In the case of stroke, issues of cognition including visual neglect, attention problems can be helped with devices that help improve focus and awareness (Movish, 2017). Technology that improves skills of attention improves decisions of cognition that strengthens current cognitive capabilities (Movish, 2017).

“As our brains change we may not attend as well. Some information may not enter into memory at all, or may not be coded in great detail” (Horgan, 2020c). Attention is often impaired within many mental health issues and with age related changes in memory (Horgan, 2020c). For example, a simple phone call may create a problem linked to attention, for an individual with cognitive impairment. The activity that the older adult was participating in prior to the phone call could be interrupted, and an inability to divide one’s attention could lead to dangerous outcomes (if the individual was, for example, in the process of waiting for a kettle to boil water). A memory lapse that stemmed from an inability to divide one’s attention, could lead to situations of embarrassment, neglect and shame. Skills of attention to multiple things at once (multitasking) is something that must be practiced, and practice videos and online programs can educate and train your brain to maintain focus and attention on critical elements within your environment (Unknown, 2016b).

Beep Seeker is, for example, a mobile game that teaches those with and without mental heath and cognitive decline issues how to focus and ignore distractions. It builds on the individual’s cognitive skills and improves attention capabilities (Unknown, 2016b). Boing is another online game that improves processing speed with game challenges that involve time sensitive reactions (Unknown, 2016b). Cognitive abilities, such as attention and working memory may be improved as a result of game participation (Unknown, 2016b).

(Unknown, 2016a)

This awareness through online education through online games could be how assistive technology can help the individual avoid difficult situations, where selective attention or a better attention span is required (in for example a busy supermarket or while simply crossing the street).

There are many wonderful videos that explore the types of attention. I believe that by watching videos like this, awareness of the need for selective attention for effective daily function can become clearer. These videos make me wonder, if older adults were able to participate in selective attention training programs, how could these skills be transferred and applied to practical situations that rely on maintained cognitive mastery? For example, driving while talking on the phone requires selective attention skill. With the use it or lose it belief system in mind, if we practice selective attention skills that support safe and effective driving, could we keep older adults on the roads and driving longer?  Check out the videos below that help you make connections between attention and optimal cognitive functioning.

(Simons, 2010)

(Dothetest, 2008)

Current Assistive Technologies: Video Games

Segal et al. (2018) suggests that if a decline in cognitive capacity happens, neurological changes can be slowed. Literature has proposed that neurological changes can be halted with prevention technologies that target depression and subsequently, cognitive decline (Segal et al., 2018). Assistive technologies; also known as cognitive prosthetics (Cole, 1999), are being used to slow this decline, and as sources of neurorehabilitation and cognitive support for individuals with acquired cognitive deficits (such as Dementia, Traumatic Brain Injury, Cerebral Vascular Incidents) (Cole, 1999). Mood disorders (such as depression and anxiety), cognitive aging, memory loss, cognitive decline and dementia are suggested to be interconnected, and they have also been targeted by assistive technologies, because it is believed that if one is prevented, associated issues will be mitigated if not prevented as well. (University of Sussex, 2018).
There are several assistive technologies that seek to improve and maintain mood, memory, attention, and cognitive function in those with a range of illnesses and disabilities of mental health and aging (Dafsari & Jessen, 2020). The first assistive technology I want to explore is one that encourages cognitive development (an idea that parallels a goal of psychodynamic intervention (Segal et al., 2018, p. 224).
It is believed that video games can in fact enhance cognitive development in older adults (Toril et al., 2014). Toril et al. (2014) suggest that video games are an ideal way for frail individuals, (and those with mild cognitive impairment) to improve their mental and physical health and quality of life, without issues of weather or transportation; as the games can be played indoors. Late life depression and cognitive control improvement has also been associated with therapies that involve video game assistive technology (Anguera et al., 2017). Some video game technology is now using interactions of older adults to shape treatments for the improvement of dementia care and cognitive functioning (Anguera et al., 2017). How you move and play the video game in your current state and with your current mental capacity, is now recorded in some games such as Sea Hero Quest for just that purpose (Unknown, 2016b).

(LifeisforsharingDT, 2019)

This game, for example, sends player data to researchers who are studying spatial navigation (Unknown, 2016b). In this game, the older adult players explore a world and complete challenges (Unknown, 2016b). The individual’s movements are recorded within the game (Unknown, 2016b). Many players who suffer with cognitive impairment and experiences of wandering (a behaviour seen with individuals with dementia), can have memory lapses while playing and forget where they are in the game. These moments, and the actions before and after this moment are what are being interpreted by scientists (Unknown, 2016b). This information breaks down spatial navigation and assists in the understanding of decision-making processes and cognitive mapping within individuals with cognitive impairment (Unknown, 2016b). It would be wonderful if games like this could prevent episodes of wandering, or help to create effective tools that can help caregivers and family members locate individuals that have gone missing. I believe that these games could also potentially generate tools that help the older adult with cognitive impairment to redirect themselves and strengthen connections required for perception, orientation and memory. What do you think? What would be another use for video games like this?

Other video games have similar promise as assistive technologies that could improve the cognitive function of older adults (Jha, 2013). Seniors have also be able to improve multitasking abilities and attention and short term memory capabilities (skills that are believed to decline with age) with the game NeuroRacer (Jha, 2013).

Tenacity video is a video game that focuses on mindfulness practice as a way to achieve cognitive improvement (Spoon, 2019a). Mindfulness; which is a state of present awareness can improve connectivity between the prefrontal and left inferior parietal cortexes of the brain (Spoon, 2019a) which in turn can improve cognitive functioning and cognitive acts of attention. Tests with this video game in younger populations, lead me to interpret that there could be great use for similar interventions with similar video games with older adults with and without mental health issues associated with aging. Check out the video and tell me what you think! 

(Spoon, 2019b)

Finally, I want to mention a well know game, SuperMario (Rense, 2017). It was determined that video games increase grey matter in the hippocampus of the brain which increased memory) (Rense, 2017). This study implied that this video game could potentially prevent cognitive decline because the game teaches spatial awareness and the construction of cognitive maps in ones head, which requires recall and memory) (Rense, 2017). When players with cognitive deficits play this game, they hypothetically, build on their skills of memory (Rense, 2017).

These games train cognitive skills, and use of video games as a therapeutic treatment within patient care plans could mean a better prognosis for patients, and cost effective care for caregivers (as some therapies can be far more expensive than the price of a console, and a few video games) (Rense, 2017). From a perspective of safety, caregivers and patients could continue to benefit from the therapy in practical settings (e.g. an older individual with dementia who plays SuperMario could in an experience of memory lapse, recall the way home from the grocery store, or remember where they left their spare key to get into their home) (Rense, 2017).

Assistive Technologies: Computer Gadgets

Quality of life can also be expanded within the lives of older adults with assistive devices with computer associated technologies (e.g. computer access software, keyboards and the internet) (Seiler, 2007). If an individual with cognitive impairment is not able to remember a letter when spelling a word, with a computer mouse, spell check is a right click away, acting as an aid to recollection (Seiler, 2007). Typing on a keyboard can also be helpful because all letters are visible on the keyboard, compensating for letter recollection difficulties (Seiler, 2007). The placement of the characters on the keyboard can aid recognition; and if the person can remember where the letter is on the keyboard, they do not need to recall the letter’s shape (Seiler, 2007).

Laptops also offer alternatives for text production and comprehension (Seiler, 2007). An older adult may have difficulty writing due to motor coordination difficulties, or have more difficulty comprehending handwritten text compared to printed text (Seiler, 2007). Literature has linked the use of tablets devices to improvements of processing speed, which can assist with the comprehension of text and the improvement of cognitive functioning (Seiler, 2007).

 (Man with headphones looking at phone, n.d.)

From computers now to books, some people with cognitive impairments can lose the ability to read a physical book. The act of listening to audio books uses a different part of the brain than is required for visually reading text within a novel. By using the technology of audio books, older adults can continue to make visual and abstract connections within their brains and strengthen their experiences through cognitive exercises (Horgan, 2020a).

(CPen, n.d.)

Reading pens are tools can also assist an individual to read and interpret what they are reading (O’Brian, 2019). These pens scan sentences in books and verbally reads the text to you (like an audio book would) (O’Brian, 2019). There is also a dictionary feature that is helpful for all individuals of all ages and ability (O’Brian, 2019). If there is a word that you cannot remember or that you are unfamiliar with, a quick scan of the word and a push of a reading pen button activates an audio clip that contains the definition of the word that you have just scanned (O’Brian, 2019). Again, this encourages the cognitive exercise of reading, and can decrease barriers to cognitive exercise (e.g. embarrassment that stems from the lack of knowledge of a word on the page) (Horgan, 2020a).

Assistive technology: App and personal device pairs

The memory handbook is a great resource that has been put together for you by the Alzheimer’s society, to educate you about memory devices that assist with day to day memory obstacles (Alzheimer’s Society, 2017). For example, it breaks down for the reader useful phone apps that help anyone who is not computer savvy to effectively use there device applications. It impacts the applications effect on caregivers, patients and family members, as it improves the chance of the application being used, and of application related outcomes of better communication and self-care (Alzheimer’s Society, 2017). One of the new digital applications that has been used to solidify neural connections and prevent the decline of cognitive awareness is Memoto, a wearable camera that individuals with mild cognitive impairment wear throughout the day (Zhang, 2012). At the end of the day, the older adult with or without mental illness is able to replay the day’s events and cue their own memory (Zhang, 2012). It was found that the use of similar wearable camera and app device pairings led to improvements in recall and spatial navigation (Gregory, 2019). Apps that also links to smart glasses were reported to have similar outcomes (Gregory, 2019).

While many applications have been successful at maintaining or improving cognitive function, it is important to note that some digital applications and programs do not improve or prevent cognitive decline (Federal Trade Commission, 2016). Luminosity, an online application and brain training program, claimed to improve cognitive skill. Their application advertising was deceptive as their claims were not backed by scientific study (Federal Trade Commission, 2016). A large lawsuit resulted and the company was fined 2 million dollars (Federal Trade Commission, 2016).

Assistive devices – Reminders and memory aids

The misplacement of words within the mind may be a reality for some individuals with cognitive impairments, however challenges are variable. Sometimes lapses in memory involve a misplacement of objects within your environment (Thomas, 2019). Locator devices exist now that help you find items within your environment (Thomas, 2019). There are reminder/locator devices that come attached to your phone in the form of phone applications and ones that can stick, clip and slip inside personal items such as wallets, tv remotes, keys, shoes, and on your electronic devices like your iPad or computer (Thomas, 2019). I personally like the Esky Wireless Item Locator because of its big easy to use buttons and charging device (Thomas, 2019). I have gotten a few for loved ones and this Christmas after checking out this website (click here), I may buy a few more.

(Thomas, 2019b)

Additional devices are improving cognitive impairments effect on the mental health of the individual with or without cognitive impairment, such as reminder phone applications that keep track of important facts that you may not remember (such as how much sleep and physical activity you have gotten in the past week) (Preston, 2016b). These apps can cue the brain of the individual to consider feelings of exhaustion, wakefulness and awareness, and strengthen neural connections (which could potentially slow cognitive impairments seen with disorders that damage neuron synapses (e.g. dementia) (Preston, 2016b).

Podcast apps, brought to us by that great assistive device, the computer, could also be very beneficial to individuals with mild cognitive impairments, care providers and caregivers (Preston, 2016b). A sip of MDTea is a podcast that educates those with cognitive impairments and caregivers, on a variety of interventions (many that include assistive technology) that delay cognitive decline, and/or improve cognitive function in older adults with and without mental illness (Preston, 2016b). It also speaks to lifestyle changes that are not directly connected to assistive technology, but they are extremely interesting ideas that I know ill be making to help keep my mind fit and active into elderhood (Preston, 2016b). I’m on episode 2.1 – Follow along with me and we can be podcast buddies 😀

(Preston, 2016a)

Conclusion

Cognitive function decreases over our lifespan, which means that humans need to adapt to these changes (Movish, 2017). Technologies for use with dementia and cognitive impairment are expanding exponentially, and many are only in the development stage, so it is up to us and our aging communities to make these innovations a priority (Movish, 2017). We can be better health care providers, caregiver and family members to those with cognitive impairment with the right tools at our fingertips. Caregiver burden can be improved, economic costs of caregiving can lessen, the possibilities are many. I feel like individuals that are aging with or without mental illness issues can all benefit from cognitive training. My research of cognitive declines role in theory and with assistive devices has made it clear that technology can preserve cognitive function in older adults, even if there is need for more research that perfects these technologies (Gregory, 2019).

Discussion of how we can adapt numerous elements of cognition (under the umbrella of cognitive function) forwards the message that there needs to be a variety of interventions to meet individuals needs and personal contexts (Movish, 2017). Strategies that strengthen existing skills and protect against cognitive decline are necessary to improving the cognition for all (Movish, 2017), as the development of cognitive skills may assist with activities of daily living and enhance the quality of life of seniors. (Vaportzis et al., 2017). I hope that you have been able to watch a video or learn about a product or concept and its connection to cognitive decline. It is a problem that affects everyone, and with today’s technology we can educate ourselves better, and strengthen global knowledge of technologies ability to prevent cognitive decline.

Thanks for Reading!

Katie

References

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