Effective Cognitive Training based on
Surface Computers
A multi-national, multicenter, randomized,
controlled efficacy study during the SOCIABLE
project
Stelios Pantelopoulos
[email protected]
Warsaw 7/10/2011
Cognitive Training as a protection tool
Cognitive Training
Personalised exercises
and activities
with various
difficulty degrees
Focuses on the systematic
exercise of specific
cognitive functions
Aiming to ameliorate or
to stablise (at least)
the cognitive functions
of the patients
Project Factsheet
•SOCIABLE – “Motivating platform for elderly networking, mental
reinforcement and social interaction”
•Programme: ICT-PSP - Objective: 1.4: ICT for ageing well with
cognitive problems, combining assistive and independent living
technologies
•Duration: 39 months (May 2009 – July 2012)
•Consortium:
SingularLogic S.A - Greece

CEDAF - Italy

University of Valencia - Spain

AIJU - Spain
--------------------------------------------------------------------------------
Trodheim Kommune - Norway

Hygeia S.A. - Greece

Municipality of Forlì, Welfare Policies Service - Italy

Forli’s Local Sanitary Organization (Geriatric department) - Italy

Social Welfare Center – Municipality o Kifissia - Greece

Fondazione Santa Lucia - Italy

PREVI S.L - Spain

Technology Providers
Pilot Organisations &
Domain Experts
What is SOCIABLE
• SOCIABLE provides next generation Cognitive Training
Services trying to strengthen social activation:


A set of Cognitive Training Activities covering all the cognitive
skills and are supported by surface computing equipment that are
performed

in a care center (in group or individual sessions) with the support
of a medical expert or a specialised care center employee or

at homes of the elderly with (or without) the support of a formal (or
informal) carer
Supported tools to the Medical Expert in order to

design the training programme and to accommodate the cognitive
training activities provided to the specific level of deficits of the
elderly (personalisation)

Monitor the evolution of its patients
SOCIABLE users

Aged/Elderly (3 Groups)

Primary
Users


Secondary
Users

Group A: Normal Elderly

Group B: Mild Cognitive Impairment

Group C: Mild Alzheimer
Medical Experts

Specialists (e.g., geriatric internists, geriatrics psychiatrists,
neurologists, neuropsychologists, nurses, social carers) that are in
charge of the aged/elderly users.

Medical experts design/configure individualized programmes for
the elderly users/ patients they are in charge.
Carers


Elderly end-users of the SOCIABLE platform
Formal or Informal carers that will in charge of the aged/elderly
users
ICT experts
Elderly Groups
• Group A:

Normal elderly people aged 65+ (patients and/or people attending
Municipal Recreation Centers).
• Group B:

Elderly people aged 65+ with Mild Cognitive Impairment (e.g., according
to the Petersen, 2001 criteria - MMSE score 26-30)
• Group C:

Elderly people aged 65+ with Mild Alzheimers disease (according to the
DSM-IV criteria - MMSE score 20-25)
SOCIABLE Service places
GROUP Session
INDIVIDUAL Session
Carer
SOCIABLE
SERVICE
Tablet PC
INDIVIDUAL Session
Surface Computing supported
Cognitive Training Sessions
SOCIABLE Surface computing equipment


Microsoft Surface Table (Care Center)
Tablet PC or ALL-IN-ONE PC (Care Center, Homes)
Key Features for our experiment

Multiuser

Multitouch

Simplicity

Progressive Disclosure

Progressive Discovery

Integrate Learning with Doing

Social interaction and multiuser Games

Spatial interaction – 2D & 3D considerations

Mixed Reality
SOCIABLE Service: A closer look
Cognitive
Assessment
Pre CT or
Post CA
Activities
Leaker
Test
Cognitive Training Program
(Duration 3 months)
Cognitive
Skills
Cognitive
Assessment
Follow up
Assessment
24 Sessions
CT Session
(60 min)
(2 per week)
Evaluation of different
Cognitive Skills
3 Months
CT Session
(60 min)
(2 per week)
Book
of Life
Session
Part 1
Session
Part 1
Activity
Z
Evaluation of different
Cognitive Skills
Cognitive
Skills
Cognitive
Skills
Game
X
Book
of Life
Book
of Life
Individual Cognitive Training Activities
(at Homes)
Evaluation of different
Cognitive Skills
Cognitive
Skills
Session (approx. 45 -60 min)
Review the
patients records
& prepare the
session
……
…
Session Part
1
Session Part
2
Activity
1
Exercis
e1
…
Performing various cognitive training activities
Update the
patient file
……
…
Session (approx. 45 – 60 min)
Activity 1
Activity
1
Review the
patient(s) files
& prepare the
session
Activity 2
Activity
1
…
Performing various cognitive training activities
Update the
patient(s) files
\\p0papalazarou\Shared_Tmp\_TMP
SOCIABLE Cognitive Training “Menu”
• Memory
–
–
–
–
–
Hide & Find
Find the Pairs
Do you remember your order
Who Belongs Where + MR
Remember the Design
• Executive Functions
–
–
–
–
–
Analogies
Take Away Menu
Picture Sort
Similarities
Differences
• Attention
– Lost in the City
– Guess Who
• Language
– Synonyms
– Antonyms
• Orientation
– My Home
– Travelling in Europe
• Logical Reasoning
– Incomplete Grids
• Constructional Praxis
– Puzzle + MR
– Copy of Figures
Book of Life Activity
\\p0papalazarou\Shared_Tmp\_TMP
SOCIABLE Cognitive Training “Menu”
• Memory
–
–
–
–
–
Hide & Find
Find the Pairs
Do you remember your order
Who Belongs Where + MR
Remember the Design
• Executive Functions
–
–
–
–
–
Analogies
Take Away Menu
Picture Sort
Similarities
Differences
• Attention
– Lost in the City
– Guess Who
• Language
– Synonyms
– Antonyms
• Orientation
– My Home
– Travelling in Europe
–
• Logical Reasoning
– Incomplete Grids
• Constructional Praxis
– Puzzle + MR
– Copy of Figures
Book of Life Activity
Details about the study
Where is SOCIABLE
4 countries - 7 Pilot Sites
350 elderly (274 care centers + 74 homes)
Microsoft Surface
PREVI Care Center
(Valencia)
40 elderly 20+20)
Municipality of
Trondheim
48 elderly (44 + 4)
Municipality of
Kifissia
60 elderly (56 + 4)
M. Pierantoni
Hospital (Forli)
50 elderly (40+10)
Fondazione Santa
Lucia (Rome)
46 elderly (40+6)
Municipality of
Forli
44 elderly (30+14)
HYGEIA
Hospital
60 elderly (44 + 16)
Status of the project
Pilot Duration - 18 months
3/2010
9/2010
2/2011
Today
Initial
Version
Pilot
Start
5/2011 TODAY
Clinical Trial
6/2012
7/2012
Project
End
Medical / Clinical Evaluation
THE STUDY PROTOCOL:
The SOCIABLE pilot study is a multi-national, multicenter, randomized,
controlled efficacy study.
Purpose:
The main objective of the study is to evaluate the effects of SOCIABLE
approach to the cognitive training and social activation of elderly users
with diagnosis of MCI, patients with Mild Alzheimer Disease (MAD) and
healty elderly subjects.
SOCIABLE Program:
•Training frequency: two sessions per week, 60 min per session (30
min for cognitive training - 30min for social activation) for twelve weeks
(24 sessions)
•Training phase: week 1 – week 12
•“Follow-up”: a delayed follow-up examination after 3 months without
training to determine whether training effects would be sustained
Medical / Clinical Evaluation
COGNITION
Orientation
Abstract reasoning
Verbal memory (long term)
INFORMED
CONSENT
Constructional
praxis
Visuo-spatial memory
Verbal
memory (short term)
•COGNITIVE-AFFECTIVEFUNCTIONAL
Executive functions
ASSESSMENT
Attention
• SOCIAL ASSESSMENT
Language
AFFECTION
FUNCTIONAL ABILITIES
SEVERITY OF DEMENTIA
SOCIAL INTERACTION
EXPERTISE IN ICT
DIAGNOSIS
Mini Mental State Examination
Clock Drawing Test
IMPACT ASSESSMENT Rey’s Auditory Verbal Learning Test
SATISFACTION QUESTIONNAIRE
Rey’s Complex Figure (copy)
Rey’s Complex Figure (delayed recall)
Digit Span
Phonological Verbal Fluency
Trail Making Test (parts A and B)
Naming Test (specific for each country)
Geriatric Depression Scale –GDS (short form)
ADL, IADL
Clinical Dementia Rating
LSNS-18; Social Preferences Questionnaire
Questionnaire of LEVEL EXPERTISE in ICT
(pre-post training)
2 sessions/week =24 sessions
T0
T1
T2
Week 1-12
Week 0
“Warm-up”
Week 16
“Follow-up”
Medical / Clinical Evaluation
STUDY POPULATION
The sample of the Pilot Operations is represented by:
•Group A: normal (cognitively intact) elderly aged 65+ .
•Group B: patients aged 65+ with MCI according to the Petersen, 2001
criteria (MMSE score 25-30).
•Group C: patients aged 65+ with mild AD according to the NINCDSARDRA criteria (MMSE score 20-24).
The SOCIABLE evaluation methodology foresees the involvement of a
CONTROL GROUP, which will be compared to the experimental group.
Subjects will be randomized to initiate immediately the SOCIABLE
treatment or to delay for three months its initiation.
The group with delayed treatment will be the “control” for the group of
immediate treatment.
Study Design: involvement of CONTROL GROUP
To this end, the FORMAL OPERATIONS PHASE (lasting 12 months) has
been subdivided in 4 quarterly phases (lasting 3 months each), each one
involving a quarter of the total number of users envisaged in the site.
Therefore the SOCIABLE users will be subdivided in 4 groups: G1, G2, G3,
G4
The Control Group will have
a 50% size of the total number
of SOCIABLE users
Medical / Clinical Evaluation
In order to evaluate the impact of SOCIABLE program on the different
cognitive skills, trained by the games, and the effect on the social
interaction and mood of the ederly involved, a complete Assessment
Battery will be administered at different stages of the SOCIABLE program:
•T0: BEFORE starting the cognitive training
•T1: AFTER the cognitive training program
•T2: FOLLOW UP assessment after 3 months from the end of the program
The Assessment Battery includes:
•Neuropsychological Tests
•Affective Assessment
•Functional Assessment
•Social Assessment
Medical / Clinical Evaluation
COGNITION
TESTS and SCALES
Orientation
Mini Mental State Examination
Abstract reasoning
Clock Drawing Test
Verbal memory (long term)
Rey’s Auditory Verbal Learning Test
Constructional praxis
Rey’s Complex Figure (copy)
Visuo-spatial memory
Rey’s Complex Figure (delayed recall)
Verbal memory (short term)
Digit Span
Executive functions
Phonological Verbal Fluency
Attention
Trail Making Test (parts A and B)
Language
Naming Test (specific for each country)
AFFECTION
Geriatric Depression Scale - GDS (short form)
FUNCTIONAL ABILITIES
ADL, IADL
SEVERITY OF DEMENTIA
Clinical Dementia Rating (CDR)
SOCIAL INTERACTION
LSNS-18 (Lubben and Gironda, 2000)
SOCIAL INTERACTION
SOCIABLE Social Preferences Questionnaire
EXPERTISE IN ICT
Questionnaire of LEVEL OF EXPERTISE in ICT (pre-post
training)
Early Results from the Pilot Operations (first quarter)
Allocation of SOCIABLE users
Demographic data
90
**
80
80
70
70
60
60
50
50
Elderly
MCI
40
Experimental group
40
30
Control group
30
20
20
10
10
0
Variable
t
Education
df
Age
MMSE T0
Sig. (2-tailed)
Age
-1,045
112
0,298
Education
-0,853
112
0,396
MMSE T0
-0,473
112
0,637
Variable
Group
Age
Experimental group
57
73,49
6,451
0,854
Control group
57
74,75
6,454
0,855
Experimental group
57
9,04
3,664
0,485
Control group
57
9,67
4,223
0,559
Experimental group
57
27,04
2,958
0,392
Control group
57
27,28
2,569
0,34
MMSE T0
AD
0
Age
Education
***
N
Mean
Std. Deviation
Std. Error Mean
Age
Elderly
MCI
AD
Total
Education
Elderly
MCI
AD
Total
MMSE T0
Elderly
MCI
AD
Total
Mean
Education
Std. Deviation N
6,808
5,441
5,567
6,455
Std. Deviation N
9,46
3,697
8,63
4,55
9,82
3,897
9,35
3,949
Std. Deviation N
28,93
1,258
27
2,386
23,57
1,665
27,16
2,761
72,29
76,3
75,89
74,12
Mean
Mean
MMSE T0
59
27
28
114
59
27
28
114
59
27
28
114
Treatment effects – Global cognition (MMSE)
30
All subjects
29.5
28
MMSE score
Experimental
Group
28.5
Elderly
28
Control
Group
27.5
*
29
29
*
T0
T1
28
MCI
27
27
26
T0
T1
25
F(1,112)=5.734, p<.05
T0
T1
25
Assessment
Group
T0
Experimental
27,04
2,958
Control
27,28
2,569
57
Total
27,16
2,761
114
Experimental
27,63
2,736
57
Control
27,23
2,739
57
Total
27,43
2,733
114
T1
Mean
Std. Deviation
N
57
24.5
AD
24
23.5
23
T0
T1
*p<.05; **p<.01; ***p<.001
Treatment effects – Memory (Rey’s words immediate)
Number of words recalled
All subjects
35
Experimental
Group
*
33
Control
Group
31
34
32
30
28
26
24
29
27
T0
43
41
39
37
35
33
31
T1
F(1,112)=10.866, p=.001
***
Elderly
T0
MCI
T0
Assessment
Group
T0
Experimental
Control
Total
30,02
33,93
31,97
16,044
15,967
16,055
57
57
114
Experimental
Control
Total
34,91
34,91
34,91
19,102
15,977
17,531
57
57
114
T1
Mean
Std. Deviation
N
T1
T1
24
AD
22
20
T0
T1
*p<.05; **p<.01; ***p<.001
Treatment effects – Attention (Trail Making Test)
All subjects
Seconds
94
90
Experimental
Group
86
Control
Group
82
130
120
110
100
90
80
70
60
50
78
74
T0
92
88
84
80
76
72
68
64
T1
F(1,109)=2.903, p=.09
*
T0
Elderly
T1
MCI
T0
T1
85
Assessment
Group
T0
Experimental
Std. Deviation
N
93,73
48,562
55
91,2
38,422
56
Total
92,45
43,56
111
Experimental
79,13
42,435
55
Control
87,84
36,467
56
Total
83,52
39,599
111
Control
T1
Mean
AD
75
65
T0
T1
*p<.05; **p<.01; ***p<.001
WP7 – Satisfaction and impact of ICT
The psychosocial Impact of Assistive Devices Scale (PIADS)
Ability
Adaptability
Self Esteem
-3
3
Satisfaction
10
Users
Care givers
21
90
79
Medical
experts
Patients vs. elderly satisfaction
USE it or LOOSE it
“Laughs best who laughs last …”
“Ages best who Ages last”
Our effort is still progressing ...
Stay tunned at http://www.sociable-project.eu
THANKS FOR YOUR ATTENTION