@Article{info:doi/10.2196/66017,
author="Kor, Kin Patrick Pui
and Liu, Wa Justina Yat
and Wong, Ching Arkers Kwan
and Tsang, Lik Alex Pak
and Tan, Zhi Han
and Cheung, Ki Daphne Sze
and Leung, Wai Humphrey Kwong
and Wong, Yuet Frances Kam",
title="Effectiveness of a Dyadic Technology--Enhanced Home-Based Horticultural Therapy on Psychosocial Well-Being Among People With Dementia and Their Family Caregivers: Multimethods Pilot Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="5",
volume="8",
pages="e66017",
keywords="horticultural activity",
keywords="dementia",
keywords="caregivers",
keywords="dyadic intervention",
keywords="technology--enhanced intervention",
abstract="Background: Horticultural therapy (HT) has been proposed to be an effective intervention for improving the psychosocial well-being of people with dementia and their caregivers. However, constraints such as limited land space in high-density cities, unstable weather, and lack of gardening experience may hamper the delivery of HT to people with dementia and their caregivers. Objective: This pilot study aimed to examine the feasibility and preliminary effects of a technology-enhanced home-based HT for people with dementia and their caregivers using a hydroponic indoor growing system. Methods: A single-group pre-post design was adopted. A total of 37 dyads of people with dementia and their caregivers participated in 3 weekly face-to-face sessions, followed by 8 weeks of home-based horticultural activities. Outcomes were measured at baseline and postintervention (at week 11), including feasibility outcomes, cognitive function, neuropsychiatric symptoms, and happiness levels of people with dementia. Caregivers' outcomes included positive aspects of caregiving, perceived stress levels, depressive symptoms, caregiver distress, and happiness levels. Semistructured focus group interviews were conducted with the caregivers to further explore their horticultural experience. Results: Intervention feasibility was established with a completion rate of 83.78\% and an attrition rate of 2.63\% (n=1). Significant improvements were detected in caregiver distress (P<.05) and the happiness level of people with dementia (P<.01). The qualitative findings indicated that HT improved the psychological well-being of both people with dementia and caregivers, enhanced the relationships between caregivers and people with dementia, expanded the caregivers' social networks, and enhanced the autobiographical memory of people with dementia. Conclusions: This pilot study provides evidence on the feasibility of using a hydroponic indoor grower to conduct home-based HT for people with dementia and their caregivers. The findings suggest positive effects on the psychological well-being of both people with dementia and their caregivers. Caregivers reported potential positive effects of HT on the autobiographical memory retrieval of people with dementia. Due to the pilot nature of this study, a control group was not employed. Therefore, large-scale randomized controlled trials are encouraged to further confirm the effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05577975; https://clinicaltrials.gov/study/NCT05577975 ",
doi="10.2196/66017",
url="https://aging.jmir.org/2025/1/e66017"
}


@Article{info:doi/10.2196/64033,
author="Nester, O. Caroline
and De Vito, N. Alyssa
and Prieto, Sarah
and Kunicki, J. Zachary
and Strenger, Jennifer
and Harrington, D. Karra
and Roque, Nelson
and Sliwinski, J. Martin
and Rabin, A. Laura
and Thompson, I. Louisa",
title="Association of Subjective Cognitive Concerns With Performance on Mobile App--Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="4",
volume="8",
pages="e64033",
keywords="subjective cognitive concerns",
keywords="subjective cognitive decline",
keywords="digital cognitive assessment",
keywords="mobile app",
keywords="app-based",
keywords="preclinical Alzheimer disease",
keywords="mild cognitive impairment",
keywords="MCI",
keywords="preclinical dementia",
keywords="mobile monitoring of cognitive change",
keywords="Cognitive Function Instrument",
keywords="mHealth",
keywords="mobile health",
keywords="applications",
keywords="cognition",
keywords="assessment",
keywords="remote",
keywords="geriatrics",
keywords="gerontology",
keywords="aging",
keywords="memory",
keywords="older adult",
keywords="elderly",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app--based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7\%; White:n=106, 86.2\%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence ({\ss}=?.20, P=.37, 95\% CI ?.65 to ?.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance ({\ss}=?.20, P=.02, 95\% CI ?.02 to ?.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=?1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. ",
doi="10.2196/64033",
url="https://aging.jmir.org/2025/1/e64033"
}


@Article{info:doi/10.2196/63457,
author="Chen, Jiaren
and Park, Jong-Hwan
and Lin, Chien-Yu
and Lai, Ting-Fu
and Kim, Du-Ri
and Shin, Myung-Jun
and Moon, Eunsoo
and Kang, Mo Jung
and Lee, Won Jong
and Cho, Jae Yoon
and Liao, Yung
and Goh, Sik Tae
and Lee, Sub Jung",
title="Whole-Body and Segmental Phase Angles and Cognitive Function in the Older Korean Population: Cross-Sectional Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="16",
volume="10",
pages="e63457",
keywords="bioelectrical impedance analysis",
keywords="oxidative stress",
keywords="cellular health",
keywords="cognitive function",
keywords="older adults",
keywords="BIA",
keywords="phase angle",
keywords="PhA",
abstract="Background: Recently, the phase angle (PhA) has emerged as an essential indicator of cellular health. Most studies have examined its association with physiological conditions, such as sarcopenia, frailty, and physical function, in older populations. Simultaneously, growing attention is being paid to the clinical relevance of segmental PhAs for future applications. However, few studies have explored the relationship between PhAs, especially segmental PhAs, and the psychological aspects of health, particularly cognitive function. Objective: We aimed to investigate the association between whole-body and segmental PhAs and cognitive function in older adults. Methods: Individuals aged 65 years and above were recruited from adult community groups residing in Busan, South Korea, through the 2022 Bus-based Screening and Assessment Network (BUSAN) study of Pusan National University Hospital. Participants' whole-body and segmental PhAs were measured using a bioelectrical impedance analyzer (BWA 2.0 Body Water Analyzer, InBody), and cognitive functions (overall and subdomains, including memory, orientation, attention and calculation, and language) were self-reported using the Korean version of the Mini-Mental State Examination. Multiple linear regression analyses were performed to examine these associations. Results: This study included 625 older adults aged 65?96 years (women: n=444, 71\%; men: n=191, 29\%). A positive association was observed between whole-body PhA and cognitive function (b=0.62, 95\% CI 0.16?1.08; P<.01). We observed significant positive associations between the PhA of the lower limbs (b=0.72, 95\% CI 0.38?1.06; P<.001) and cognitive function. Analysis of the Mini-Mental State Examination subdomains revealed that whole-body PhA was significantly related to memory (b=0.11, 95\% CI 0.00?0.22; P=.04); the PhA of the upper limbs was significantly related to orientation (b=0.29, 95\% CI 0.09?0.49; P=.01); and the PhA of the lower limbs was significantly related to orientation (b=0.24, 95\% CI 0.10?0.38; P<.001), attention and calculation (b=0.21, 95\% CI 0.06?0.37; P=.01), memory (b=0.14, 95\% CI 0.05?0.22; P=.001), and language functions (b=0.07, 95\% CI 0.01?0.12; P=.01). However, trunk PhA showed no significant association. Conclusions: Our findings bolster the emerging evidence of a significant positive correlation between whole-body PhA and cognitive function in our sample, with nuanced relationships observed across different segmental PhAs and cognitive subdomains. Therefore, this study revealed that PhAs could be a useful tool for screening or preventing cognitive decline in the general older population, offering substantial evidence for future interventional studies. Further research should delve into the mechanisms and assess targeted interventions that enhance regional physical function to support cognitive health in older adults. Further long-term investigation on these associations is warranted. ",
doi="10.2196/63457",
url="https://publichealth.jmir.org/2024/1/e63457"
}


@Article{info:doi/10.2196/56796,
author="Bruni, Francesca
and Mancuso, Valentina
and Panigada, Jonathan
and Stramba-Badiale, Marco
and Cipresso, Pietro
and Pedroli, Elisa",
title="Exploring How Older Adults Experience semAPP, a 360{\textdegree} Media--Based Tool for Memory Assessment: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Dec",
day="5",
volume="7",
pages="e56796",
keywords="assessment",
keywords="virtual reality",
keywords="360-degree videos",
keywords="user experience",
keywords="memory",
keywords="aging",
keywords="psycho gerontology",
abstract="Background: Technology is already a part of our daily lives, and its influence is growing rapidly. This evolution has not spared the health care field. Nowadays, a crucial challenge is considering aspects such as design, development, and implementation, highlighting their functionality, ease of use, compatibility, performance, and safety when a new technological tool is developed. As noted in many works, the abandonment rate is usually higher when a user has a terrible experience with these instruments. It would be appropriate to incorporate the final users---whether they are patients, health care professionals, or both---in the stages of instrument design to understand their needs and preferences. Since most apps that fail did not include end users and health care professionals in the development phase, their involvement at all stages of app development may increase their commitment and improve integration, self-management, and health outcomes. Objective: This study aims (1) to develop semAPP (spatial and episodic memory assessment application), a 360{\textdegree} media--based tool, to assess memory in aging by simulating a real-life situation and (2) to test the usability of the app and the connected experience in an end-user population. Methods: A total of 34 older adults participated in the study: 16 (47\%) healthy individuals and 18 (53\%) patients with mild cognitive impairment. They used semAPP and completed qualitative and quantitative measures. The app includes 2 parts: object recognition and spatial memory tasks. During the first task, users have to navigate in an apartment freely and visit rooms, and then they must recognize the right map of the house. In the second task, users are immersed in a living room, and they have to encode and then recall some target objects, simulating a relocation. We deployed this app on an 11.2-inch iPad, and we tested its usability and the experience of users interacting with the app. We conducted descriptive analyses for both the entire sample and each subgroup; we also conducted parametric and correlation analyses to compare groups and to examine the relationship between task execution and the virtual experience, as well as the acceptance of technology. Results: Both groups judged the app as an easy-to-use tool, and they were willing to use it. Moreover, the results match the idea that usability might be influenced by different factors depending on instrument and personal features, such as presentation, functionality, system performance, interactive behavior, attitudes, skills, and personality. Conclusions: The findings support the possibility of using semAPP in older patients, as well as the importance of designing and evaluating new technological tools, considering not only the general population but also the specific target ones. ",
doi="10.2196/56796",
url="https://aging.jmir.org/2024/1/e56796"
}


@Article{info:doi/10.2196/55562,
author="Kubickova, Veronika
and Steel, Craig
and Moulds, L. Michelle
and Kanstrup, Marie
and Beer, Sally
and Darwent, Melanie
and Keating, Liza
and Holmes, A. Emily
and Iyadurai, Lalitha",
title="Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="18",
volume="11",
pages="e55562",
keywords="intrusive memories",
keywords="digital intervention",
keywords="psychological trauma",
keywords="remote delivery",
keywords="health care staff",
keywords="COVID-19",
keywords="case series",
abstract="Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. Results: There was a decrease (59\%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size ($\tau$-U=--0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step. ",
doi="10.2196/55562",
url="https://humanfactors.jmir.org/2024/1/e55562"
}


@Article{info:doi/10.2196/47496,
author="Lau, Cassandra Regine
and Anderson, John Peter
and Wiley, F. Joshua
and Huang, Derek
and Surjatin, Faisha
and McIntosh, Paul
and Gathercole, Susan
and Spencer-Smith, Megan",
title="Working Memory Training for Children Using the Adaptive, Self-Select, and Stepwise Approaches to Setting the Difficulty Level of Training Activities: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="19",
volume="12",
pages="e47496",
keywords="children",
keywords="working memory",
keywords="memory training",
keywords="adaptive training",
keywords="cognitive training",
keywords="transfer effects",
keywords="training effects",
keywords="cognitive outcomes",
keywords="randomized controlled trial",
abstract="Background: A common yet untested assumption of cognitive training in children is that activities should be adaptive, with difficulty adjusted to the individual's performance in order to maximize improvements on untrained tasks (known as transfer). Working memory training provides the ideal testbed to systematically examine this assumption as it is one of the most widely studied domains in the cognitive training literature, and is critical for children's learning, including following instructions and reasoning. Objective: This trial aimed to examine children's outcomes of working memory training using adaptive, self-select (child selects difficulty level), and stepwise (difficulty level increases incrementally) approaches to setting the difficulty of training activities compared to an active control condition immediately and 6-month postintervention. While the aim is exploratory, we hypothesized that children allocated to a working memory training condition would show greater improvements: (1) on near transfer measures compared to intermediate and far transfer measures and (2) immediately postintervention compared to 6-month postintervention. Methods: This double-blinded, active-controlled, parallel-group randomized trial aimed to recruit 128 children aged 7 to 11 years from 1 metropolitan primary school in Melbourne, Australia. Following baseline testing, children were randomized into 1 of 4 conditions: adaptive, self-select, or stepwise working memory training, or active control. An experimental intervention embedded in Minecraft was developed for teachers to deliver in class over 2 consecutive weeks (10 {\texttimes} 20-minute sessions). The working memory training comprised 2 training activities with processing demands similar to daily activities: backward span and following instructions. The control comprised creative activities. Pre- and postintervention, children completed a set of working memory tests (near and intermediate transfer) and the Raven's Standard Progressive Matrices (far transfer) to determine training outcomes, as well as motivation questionnaires to determine if motivations toward learning and the intervention were similar across conditions. Caregivers completed the ADHD-Rating Scale-5 to measure their child's attention (far transfer). Statistical analysis will include traditional null hypothesis significance testing and Bayesian methods to quantify evidence for both the null and alternative hypotheses. Results: Data collection concluded in December 2022. Data are currently being processed and analyzed. Conclusions: This trial will determine whether the adaptive approach to setting the difficulty of training activities maximizes cognitive training outcomes for children. This trial has several strengths: it adopts best practices for cognitive training studies (design, methods, and analysis plan); uses a range of measures to detect discrete levels of transfer; has a 6-month postintervention assessment; is appropriately powered; and uses an experimental working memory training intervention based on our current understanding of the cognitive mechanisms of training. Findings will inform future research and design of cognitive training interventions and highlight the value of the evidence-based principles of cognitive training. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12621000990820; https://www.anzctr.org.au/ACTRN12621000990820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/47496 ",
doi="10.2196/47496",
url="https://www.researchprotocols.org/2023/1/e47496",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725418"
}


@Article{info:doi/10.2196/38552,
author="Babaei, Nazanin
and Kerry, Camrie
and Goode, Kisha
and Dang, Kevin
and Mirzadeh, Parsa
and Pirbaglou, Meysam
and Kirk, A. Megan
and Ritvo, Paul",
title="Clinical Assessment of Eye Movement Desensitization and Reprocessing in Memory Distress: Protocol for a Double-Blinded Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="12",
volume="12",
pages="e38552",
keywords="EMDR variants",
keywords="eye movement desensitization reprocessing",
keywords="flash technique-EMDR",
keywords="posttraumatic stress disorder",
abstract="Background: Exposures to ``traumatic'' events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. Objective: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. Methods: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. Results: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. Conclusions: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory--related distress. Trial Registration: ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127 ",
doi="10.2196/38552",
url="https://www.researchprotocols.org/2023/1/e38552",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171869"
}


@Article{info:doi/10.2196/39720,
author="Bui, An Truong
and Rosenfelt, Scott Cory
and Whitlock, Hope Kerri
and Leclercq, Mickael
and Weber, Savannah
and Droit, Arnaud
and Wiebe, A. Sandra
and Pei, Jacqueline
and Bolduc, V. Francois",
title="Long-term Memory Testing in Children With Typical Development and Neurodevelopmental Disorders: Remote Web-based Image Task Feasibility Study",
journal="JMIR Pediatr Parent",
year="2023",
month="May",
day="8",
volume="6",
pages="e39720",
keywords="memory",
keywords="neurodevelopmental disorder",
keywords="autism spectrum disorder",
keywords="intellectual disability",
keywords="developmental delay",
keywords="hippocampus",
keywords="recognition",
keywords="paired association learning",
keywords="remote testing",
keywords="autism",
keywords="disorder",
keywords="genetics",
keywords="developmental",
keywords="developmental disorder",
keywords="game",
keywords="remote",
keywords="testing",
keywords="diagnose",
keywords="diagnosis",
abstract="Background: Neurodevelopmental disorders (NDD) cause individuals to have difficulty in learning facts, procedures, or social skills. NDD has been linked to several genes, and several animal models have been used to identify potential therapeutic candidates based on specific learning paradigms for long-term and associative memory. In individuals with NDD, however, such testing has not been used so far, resulting in a gap in translating preclinical results to clinical practice. Objective: We aim to assess if individuals with NDD could be tested for paired association learning and long-term memory deficit, as shown in previous animal models. Methods: We developed an image-based paired association task, which can be performed at different time points using remote web-based testing, and evaluated its feasibility in children with typical development (TD), as well as NDD. We included 2 tasks: object recognition as a simpler task and paired association. Learning was tested immediately after training and also the next day for long-term memory. Results: We found that children aged 5-14 years with TD (n=128) and with NDD of different types (n=57) could complete testing using the Memory Game. Children with NDD showed deficits in both recognition and paired association tasks on the first day of learning, in both 5-9--year old (P<.001 and P=.01, respectively) and 10-14--year old groups (P=.001 and P<.001, respectively). The reaction times to stimuli showed no significant difference between individuals with TD or NDD. Children with NDD exhibited a faster 24-hour memory decay for the recognition task than those with TD in the 5-9--year old group. This trend is reversed for the paired association task. Interestingly, we found that children with NDD had their retention for recognition improved and matched with typically developing individuals by 10-14 years of age. The NDD group also showed improved retention deficits in the paired association task at 10-14 years of age compared to the TD group. Conclusions: We showed that web-based learning testing using simple picture association is feasible for children with TD, as well as with NDD. We showed how web-based testing allows us to train children to learn the association between pictures, as shown in immediate test results and those completed 1 day after. This is important as many models for learning deficits in NDD target both short- and long-term memory for therapeutic intervention. We also demonstrated that despite potential confounding factors, such as self-reported diagnosis bias, technical issues, and varied participation, the Memory Game shows significant differences between typically developing children and those with NDD. Future experiments will leverage this potential of web-based testing for larger cohorts and cross-validation with other clinical or preclinical cognitive tasks. ",
doi="10.2196/39720",
url="https://pediatrics.jmir.org/2023/1/e39720",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155237"
}


@Article{info:doi/10.2196/41712,
author="Pike, Kerryn
and Moller, I. Carl
and Bryant, Christina
and Farrow, Maree
and Dao, P. Duy
and Ellis, A. Kathryn",
title="Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday Program for Older Adults: Single-Arm Pre-Post Trial",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="20",
volume="25",
pages="e41712",
keywords="cognition",
keywords="learning",
keywords="internet-based intervention",
keywords="social support",
keywords="subjective cognitive decline",
keywords="mobile phone",
abstract="Background: Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. Objective: We report on OPTIMiSE's feasibility, acceptability, and efficacy. Methods: Australians aged ?60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. Results: OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6\%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4\% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=?0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. Conclusions: This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv International Registered Report Identifier (IRRID): RR2-10.3233/ADR-200251 ",
doi="10.2196/41712",
url="https://www.jmir.org/2023/1/e41712",
url="http://www.ncbi.nlm.nih.gov/pubmed/37079356"
}


@Article{info:doi/10.2196/44007,
author="Brown, L. Ellen
and Ruggiano, Nicole
and Allala, Chaithra Sai
and Clarke, J. Peter
and Davis, Debra
and Roberts, Lisa
and Framil, Victoria C.
and Mu{\~n}oz, Hernandez Mar{\'i}ateresa Teri
and Hough, Strauss Monica
and Bourgeois, S. Michelle",
title="Developing a Memory and Communication App for Persons Living With Dementia: An 8-Step Process",
journal="JMIR Aging",
year="2023",
month="Mar",
day="15",
volume="6",
pages="e44007",
keywords="health technology",
keywords="interdisiplinary team",
keywords="older adults",
keywords="dementia",
keywords="communication",
keywords="communication aids for disabled persons",
keywords="communication boards",
keywords="app",
keywords="Alzheimer disease",
keywords="family",
keywords="caregiver",
keywords="clinical care",
keywords="development",
keywords="speech",
keywords="psychosocial intervention",
keywords="software design",
abstract="International Registered Report Identifier (IRRID): RR2-10.3928/19404921-20210825-02 ",
doi="10.2196/44007",
url="https://aging.jmir.org/2023/1/e44007",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920462"
}


@Article{info:doi/10.2196/42519,
author="Athanasiou, Maria
and Fragkozidis, Georgios
and Zarkogianni, Konstantia
and Nikita, S. Konstantina",
title="Long Short-term Memory--Based Prediction of the Spread of Influenza-Like Illness Leveraging Surveillance, Weather, and Twitter Data: Model Development and Validation",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="6",
volume="25",
pages="e42519",
keywords="influenza-like illness",
keywords="epidemiological surveillance",
keywords="machine learning",
keywords="deep learning",
keywords="social media",
keywords="Twitter",
keywords="meteorological parameters",
abstract="Background: The potential to harness the plurality of available data in real time along with advanced data analytics for the accurate prediction of influenza-like illness (ILI) outbreaks has gained significant scientific interest. Different methodologies based on the use of machine learning techniques and traditional and alternative data sources, such as ILI surveillance reports, weather reports, search engine queries, and social media, have been explored with the ultimate goal of being used in the development of electronic surveillance systems that could complement existing monitoring resources. Objective: The scope of this study was to investigate for the first time the combined use of ILI surveillance data, weather data, and Twitter data along with deep learning techniques toward the development of prediction models able to nowcast and forecast weekly ILI cases. By assessing the predictive power of both traditional and alternative data sources on the use case of ILI, this study aimed to provide a novel approach for corroborating evidence and enhancing accuracy and reliability in the surveillance of infectious diseases. Methods: The model's input space consisted of information related to weekly ILI surveillance, web-based social (eg, Twitter) behavior, and weather conditions. For the design and development of the model, relevant data corresponding to the period of 2010 to 2019 and focusing on the Greek population and weather were collected. Long short-term memory (LSTM) neural networks were leveraged to efficiently handle the sequential and nonlinear nature of the multitude of collected data. The 3 data categories were first used separately for training 3 LSTM-based primary models. Subsequently, different transfer learning (TL) approaches were explored with the aim of creating various feature spaces combining the features extracted from the corresponding primary models' LSTM layers for the latter to feed a dense layer. Results: The primary model that learned from weather data yielded better forecast accuracy (root mean square error [RMSE]=0.144; Pearson correlation coefficient [PCC]=0.801) than the model trained with ILI historical data (RMSE=0.159; PCC=0.794). The best performance was achieved by the TL-based model leveraging the combination of the 3 data categories (RMSE=0.128; PCC=0.822). Conclusions: The superiority of the TL-based model, which considers Twitter data, weather data, and ILI surveillance data, reflects the potential of alternative public sources to enhance accurate and reliable prediction of ILI spread. Despite its focus on the use case of Greece, the proposed approach can be generalized to other locations, populations, and social media platforms to support the surveillance of infectious diseases with the ultimate goal of reinforcing preparedness for future epidemics. ",
doi="10.2196/42519",
url="https://www.jmir.org/2023/1/e42519",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745490"
}


@Article{info:doi/10.2196/40188,
author="Hakun, G. Jonathan
and Roque, A. Nelson
and Gerver, R. Courtney
and Cerino, S. Eric",
title="Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="27",
volume="7",
pages="e40188",
keywords="ecological momentary assessment",
keywords="EMA",
keywords="mobile cognitive assessment",
keywords="working memory capacity",
keywords="measurement burst design",
keywords="mobile phone",
abstract="Background: The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an ``ambulatory'' cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Objective: Across 3 studies, we adapted ``complex span'' tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. Methods: In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Results: Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Conclusions: Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed. ",
doi="10.2196/40188",
url="https://formative.jmir.org/2023/1/e40188",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705953"
}


@Article{info:doi/10.2196/36294,
author="Grecco, H. Leandro
and Gon{\c{c}}alves, R. Giuliano
and Perri, Neiva B{\'a}rbara
and Bispo, Alexander Breno
and Grandin, Jorge Isabella Favilla
and Gomes, Dias Paula Valentina Nunes
and Bocchi, Alexandre Andr{\'e}
and Oliveira, Martinez Kennedy
and Maldonado, Correa Diogo
and Silva, da Marcelo Cavenaghi Pereira",
title="Association of Transcranial Direct Current Stimulation and Neurofeedback With Declarative Memory and Cerebral Arterial Flow in University Students: Protocol for a Double-blind Randomized Controlled Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="26",
volume="11",
number="8",
pages="e36294",
keywords="transcranial direct current stimulation",
keywords="neurofeedback stimulation",
keywords="TDCS",
keywords="memory",
keywords="Doppler ultrasonography",
keywords="arterial flow",
keywords="brain stimulation",
keywords="electrical stimulation",
keywords="transcranial",
keywords="neurofeedback",
keywords="brain",
keywords="neurology",
keywords="cerebral",
keywords="blood flow",
keywords="cerebrum",
keywords="declarative memory",
keywords="double-blind",
keywords="controlled trial",
keywords="RCT",
keywords="randomized controlled trial",
keywords="university",
keywords="college",
keywords="student",
keywords="postsecondary",
keywords="graduate",
keywords="undergraduate",
abstract="Background: The performance of a task depends on ongoing brain activity, which can be influenced by attention, excitement, or motivation. Scientific studies have confirmed that mindfulness leads to better performance, health, and well-being. However, these cognitive efficiency modulating factors are nonspecific, can be difficult to control, and are not suitable to specifically facilitate neural processing. Objective: The aim of this study is to evaluate the effects of transcranial direct current stimulation associated with neurofeedback on declarative memory and cerebral blood flow in university students. Methods: In this study, we will use transcranial direct current stimulation, a low-cost physical resource that is easy to apply, has few adverse effects, and is associated with a neurofeedback resource. This, in turn, has been shown to be a training program capable of improving working memory function. Results: Participants will be recruited between July 2022 and December 2022. This study is expected to conclude in July 2023. Conclusions: This study will provide preliminary results on the benefits of using the direct current neurostimulation and neurofeedback tools on the participants being analyzed. Trial Registration: Brazilian Clinical Trials Registry RBR-7zs8b5; https://ensaiosclinicos.gov.br/rg/RBR-7zs8b5 International Registered Report Identifier (IRRID): PRR1-10.2196/36294 ",
doi="10.2196/36294",
url="https://www.researchprotocols.org/2022/8/e36294",
url="http://www.ncbi.nlm.nih.gov/pubmed/36018619"
}


@Article{info:doi/10.2196/35202,
author="Abd-alrazaq, Alaa
and Alhuwail, Dari
and Al-Jafar, Eiman
and Ahmed, Arfan
and Shuweihdi, Farag
and Reagu, Mohd Shuja
and Househ, Mowafa",
title="The Effectiveness of Serious Games in Improving Memory Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis",
journal="JMIR Serious Games",
year="2022",
month="Aug",
day="9",
volume="10",
number="3",
pages="e35202",
keywords="serious games",
keywords="cognitive training",
keywords="exergames",
keywords="mild cognitive impairment",
keywords="Alzheimer disease",
keywords="dementia",
keywords="memory",
keywords="systematic reviews",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Memory, one of the main cognitive functions, is known to decline with age. Serious games have been used for improving memory in older adults. The effectiveness of serious games in improving memory has been assessed by many studies. To draw definitive conclusions about the effectiveness of serious games, the findings of these studies need to be pooled and aggregated. Objective: This study aimed to assess the effectiveness of serious games in improving memory in older adults with cognitive impairment. Methods: A systematic review of randomized controlled trials was carried out. The search sources included 8 databases, the reference lists of the included studies and relevant reviews, and the studies that cited the included studies. In total, 2 reviewers (AA and MH) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (ie, multilevel meta-analysis), as appropriate. Results: Of the 618 citations retrieved, 18 (2.9\%) met the eligibility criteria for this review. Of these 18 studies, 15 (83\%) randomized controlled trials were included in 10 multilevel meta-analyses. We found that serious games were more effective than no or passive interventions in improving nonverbal memory (P=.02; standardized mean difference [SMD]=0.46, 95\% CI 0.09-0.83) and working memory (P=.04; SMD=0.31, 95\% CI 0.01-0.60) but not verbal memory (P=.13; SMD=0.39, 95\% CI ?0.11 to 0.89). The review also showed that serious games were more effective than conventional exercises in improving verbal memory (P=.003; SMD=0.46, 95\% CI 0.16-0.77) but not nonverbal memory (P=.30; SMD=?0.19, 95\% CI ?0.54 to 0.17) or working memory (P=.99; SMD=0.00, 95\% CI ?0.45 to 0.45). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=.14; SMD=0.66, 95\% CI ?0.21 to 1.54), nonverbal memory (P=.94; SMD=?0.01, 95\% CI ?0.32 to 0.30), and working memory (P=.08; SMD=0.37, 95\% CI ?0.05 to 0.78) among older adults with cognitive impairment. Finally, the effect of adaptive serious games on working memory was comparable with that of nonadaptive serious games (P=.08; SMD=0.18, 95\% CI ?0.02 to 0.37). Conclusions: Serious games have the potential to improve verbal, nonverbal, and working memory in older adults with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (?3) and judged to have a low quality of evidence. Therefore, serious games should be offered as a supplement to existing proven and safe interventions rather than as a complete substitute until further, more robust evidence is available. Future studies should investigate the short- and long-term effects of serious games on memory and other cognitive abilities among people of different age groups with or without cognitive impairment. ",
doi="10.2196/35202",
url="https://games.jmir.org/2022/3/e35202",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943792"
}


@Article{info:doi/10.2196/34583,
author="Chang, Yung-Chun
and Chiu, Yu-Wen
and Chuang, Ting-Wu",
title="Linguistic Pattern--Infused Dual-Channel Bidirectional Long Short-term Memory With Attention for Dengue Case Summary Generation From the Program for Monitoring Emerging Diseases--Mail Database: Algorithm Development Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="13",
volume="8",
number="7",
pages="e34583",
keywords="ProMED-mail",
keywords="natural language processing",
keywords="dengue",
keywords="dual channel",
keywords="bidirectional long short-term memory",
abstract="Background: Globalization and environmental changes have intensified the emergence or re-emergence of infectious diseases worldwide, such as outbreaks of dengue fever in Southeast Asia. Collaboration on region-wide infectious disease surveillance systems is therefore critical but difficult to achieve because of the different transparency levels of health information systems in different countries. Although the Program for Monitoring Emerging Diseases (ProMED)--mail is the most comprehensive international expert--curated platform providing rich disease outbreak information on humans, animals, and plants, the unstructured text content of the reports makes analysis for further application difficult. Objective: To make monitoring the epidemic situation in Southeast Asia more efficient, this study aims to develop an automatic summary of the alert articles from ProMED-mail, a huge textual data source. In this paper, we proposed a text summarization method that uses natural language processing technology to automatically extract important sentences from alert articles in ProMED-mail emails to generate summaries. Using our method, we can quickly capture crucial information to help make important decisions regarding epidemic surveillance. Methods: Our data, which span a period from 1994 to 2019, come from the ProMED-mail website. We analyzed the collected data to establish a unique Taiwan dengue corpus that was validated with professionals' annotations to achieve almost perfect agreement (Cohen $\kappa$=90\%). To generate a ProMED-mail summary, we developed a dual-channel bidirectional long short-term memory with attention mechanism with infused latent syntactic features to identify key sentences from the alerting article. Results: Our method is superior to many well-known machine learning and neural network approaches in identifying important sentences, achieving a macroaverage F1 score of 93\%. Moreover, it can successfully extract the relevant correct information on dengue fever from a ProMED-mail alerting article, which can help researchers or general users to quickly understand the essence of the alerting article at first glance. In addition to verifying the model, we also recruited 3 professional experts and 2 students from related fields to participate in a satisfaction survey on the generated summaries, and the results show that 84\% (63/75) of the summaries received high satisfaction ratings. Conclusions: The proposed approach successfully fuses latent syntactic features into a deep neural network to analyze the syntactic, semantic, and contextual information in the text. It then exploits the derived information to identify crucial sentences in the ProMED-mail alerting article. The experiment results show that the proposed method is not only effective but also outperforms the compared methods. Our approach also demonstrates the potential for case summary generation from ProMED-mail alerting articles. In terms of practical application, when a new alerting article arrives, our method can quickly identify the relevant case information, which is the most critical part, to use as a reference or for further analysis. ",
doi="10.2196/34583",
url="https://publichealth.jmir.org/2022/7/e34583",
url="http://www.ncbi.nlm.nih.gov/pubmed/35830225"
}


@Article{info:doi/10.2196/33682,
author="Jones, Chelsea
and Smith-MacDonald, Lorraine
and Brown, G. Matthew R.
and VanDehy, Jacob
and Grunnet-Jepsen, Rasmus
and Ordek, P. Vrajeshri
and Kruger, Sarah
and Ayres Gerhart, Anne
and van Veelen, Nancy
and Nijdam, J. Mirjam
and Burback, Lisa
and Cao, Bo
and Roy, J. Michael
and Sessoms, Pinata
and Vermetten, Eric
and Br{\'e}mault-Phillips, Suzette",
title="The Redesign and Validation of Multimodal Motion-Assisted Memory Desensitization and Reconsolidation Hardware and Software: Mixed Methods, Modified Delphi--Based Validation Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="12",
volume="9",
number="3",
pages="e33682",
keywords="multimodal motion-assisted memory desensitization and reconsolidation",
keywords="3MDR",
keywords="participants",
keywords="therapists",
keywords="patients",
keywords="military",
keywords="virtual reality",
keywords="mobile phone",
abstract="Background: In recent years, the delivery of evidence-based therapies targeting posttraumatic stress disorder (PTSD) has been the focus of the Departments of Defense in countries such as Canada, the Netherlands, and the United States. More than 66\% of military members continue to experience symptoms of PTSD that significantly impact their daily functioning and quality of life after completing evidence-based treatments. Innovative, engaging, and effective treatments for PTSD are needed. Multimodal motion-assisted memory desensitization and reconsolidation (3MDR) is an exposure-based, virtual reality--supported therapy used to treat military members and veterans with treatment-resistant PTSD. Given the demonstrated efficacy of 3MDR in recently published randomized control trials, there is both an interest in and a need to adapt the intervention to other populations affected by trauma and to improve accessibility to the treatment. Objective: We aimed to further innovate, develop, and validate new and existing hardware and software components of 3MDR to enhance its mobility, accessibility, feasibility, and applicability to other populations affected by trauma, including public safety personnel (PSP), via international collaboration. Methods: This study used a modified Delphi expert consultation method and mixed methods quasi-experimental validation with the purpose of software validation among PSP (first responders, health care providers) participants (N=35). A team of international experts from the Netherlands, the United States, and Canada met on the web on a weekly basis since September 2020 to discuss the adoption of 3MDR in real-world contexts, hardware and software development, and software validation. The evolution of 3MDR hardware and software was undertaken followed by a mixed methods software validation study with triangulation of results to inform the further development of 3MDR. Results: This study resulted in the identification, description, and evolution of hardware and software components and the development of new 3MDR software. Within the software validation, PSP participants widely acknowledged that the newly developed 3MDR software would be applicable and feasible for PSP affected by trauma within their professions. The key themes that emerged from the thematic analysis among the PSP included the desire for occupationally tailored environments, individually tailored immersion, and the applicability of 3MDR beyond military populations. Conclusions: Within the modified Delphi consultation and software validation study, support for 3MDR as an intervention was communicated. PSP participants perceived that 3MDR was relevant for populations affected by trauma beyond military members and veterans. The resulting hardware and software evolution addressed the recommendations and themes that arose from PSP participants. 3MDR is a novel, structured, exposure-based, virtual reality--supported therapy that is currently used to treat military members and veterans with PTSD. Going forward, it is necessary to innovate and adapt 3MDR, as well as other trauma interventions, to increase effectiveness, accessibility, cost-effectiveness, and efficacy among other populations affected by trauma. ",
doi="10.2196/33682",
url="https://humanfactors.jmir.org/2022/3/e33682",
url="http://www.ncbi.nlm.nih.gov/pubmed/35819834"
}


@Article{info:doi/10.2196/35295,
author="Redlinger, Eric
and Glas, Bernhard
and Rong, Yang",
title="Impact of Visual Game-Like Features on Cognitive Performance in a Virtual Reality Working Memory Task: Within-Subjects Experiment",
journal="JMIR Serious Games",
year="2022",
month="Apr",
day="28",
volume="10",
number="2",
pages="e35295",
keywords="HMD",
keywords="working memory",
keywords="gamification",
keywords="cognitive training",
keywords="serious game",
keywords="game",
keywords="cognitive activity",
keywords="user performance",
keywords="visual memory",
keywords="cognitive",
keywords="mobile phone",
abstract="Background: Although the pursuit of improved cognitive function through working memory training has been the subject of decades of research, the recent growth in commercial adaptations of classic working memory tasks in the form of gamified apps warrants additional scrutiny. In particular, the emergence of virtual reality as a platform for cognitive training presents opportunities for the use of novel visual features. Objective: This study aimed to add to the body of knowledge regarding the use of game-like visual design elements by specifically examining the application of two particular visual features common to virtual reality environments: immersive, colorful backgrounds and the use of 3D depth. In addition, electroencephalography (EEG) data were collected to identify potential neural correlates of any observed changes in performance. Methods: A simple visual working memory task was presented to participants in several game-like adaptations, including the use of colorful, immersive backgrounds and 3D depth. The impact of each adaptation was separately assessed using both EEG and performance assessment outcomes and compared with an unmodified version of the task. Results: Results suggest that although accuracy and reaction time may be slightly affected by the introduction of such game elements, the effects were small and not statistically significant. Changes in EEG power, particularly in the beta and theta rhythms, were significant but failed to correlate with any corresponding changes in performance. Therefore, they may only reflect cognitive changes at the perceptual level. Conclusions: Overall, the data suggest that the addition of these specific visual features to simple cognitive tasks does not appear to significantly affect performance or task-dependent cognitive load. ",
doi="10.2196/35295",
url="https://games.jmir.org/2022/2/e35295",
url="http://www.ncbi.nlm.nih.gov/pubmed/35482373"
}


@Article{info:doi/10.2196/31552,
author="Albers, A. Elizabeth
and Mikal, Jude
and Millenbah, Ashley
and Finlay, Jessica
and Jutkowitz, Eric
and Mitchell, Lauren
and Horn, Brenna
and Gaugler, E. Joseph",
title="The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="17",
volume="5",
number="1",
pages="e31552",
keywords="social isolation",
keywords="dementia",
keywords="caregiving - informal",
keywords="aging in place",
keywords="caregivers",
keywords="aging",
keywords="elderly",
keywords="pandemic",
keywords="COVID-19",
keywords="mental health",
keywords="technology use",
keywords="health technology",
abstract="Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. ",
doi="10.2196/31552",
url="https://aging.jmir.org/2022/1/e31552",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134748"
}


@Article{info:doi/10.2196/28880,
author="Liao, JunHua
and Liu, LunXin
and Duan, HaiHan
and Huang, YunZhi
and Zhou, LiangXue
and Chen, LiangYin
and Wang, ChaoHua",
title="Using a Convolutional Neural Network and Convolutional Long Short-term Memory to Automatically Detect Aneurysms on 2D Digital Subtraction Angiography Images: Framework Development and Validation",
journal="JMIR Med Inform",
year="2022",
month="Mar",
day="16",
volume="10",
number="3",
pages="e28880",
keywords="convolutional neural network",
keywords="convolutional long short-term memory",
keywords="cerebral aneurysm",
keywords="deep learning",
abstract="Background: It is hard to distinguish cerebral aneurysms from overlapping vessels in 2D digital subtraction angiography (DSA) images due to these images' lack of spatial information. Objective: The aims of this study were to (1) construct a deep learning diagnostic system to improve the ability to detect posterior communicating artery aneurysms on 2D DSA images and (2) validate the efficiency of the deep learning diagnostic system in 2D DSA aneurysm detection. Methods: We proposed a 2-stage detection system. First, we established the region localization stage to automatically locate specific detection regions of raw 2D DSA sequences. Second, in the intracranial aneurysm detection stage, we constructed a bi-input+RetinaNet+convolutional long short-term memory (C-LSTM) framework to compare its performance for aneurysm detection with that of 3 existing frameworks. Each of the frameworks had a 5-fold cross-validation scheme. The receiver operating characteristic curve, the area under the curve (AUC) value, mean average precision, sensitivity, specificity, and accuracy were used to assess the abilities of different frameworks. Results: A total of 255 patients with posterior communicating artery aneurysms and 20 patients without aneurysms were included in this study. The best AUC values of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks were 0.95, 0.96, 0.92, and 0.97, respectively. The mean sensitivities of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 89\% (range 67.02\%-98.43\%), 88\% (range 65.76\%-98.06\%), 87\% (range 64.53\%-97.66\%), 89\% (range 67.02\%-98.43\%), and 90\% (range 68.30\%-98.77\%), respectively. The mean specificities of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 80\% (range 56.34\%-94.27\%), 89\% (range 67.02\%-98.43\%), 86\% (range 63.31\%-97.24\%), 93\% (range 72.30\%-99.56\%), and 90\% (range 68.30\%-98.77\%), respectively. The mean accuracies of the RetinaNet, RetinaNet+C-LSTM, bi-input+RetinaNet, and bi-input+RetinaNet+C-LSTM frameworks and human experts were 84.50\% (range 69.57\%-93.97\%), 88.50\% (range 74.44\%-96.39\%), 86.50\% (range 71.97\%-95.22\%), 91\% (range 77.63\%-97.72\%), and 90\% (range 76.34\%-97.21\%), respectively. Conclusions: According to our results, more spatial and temporal information can help improve the performance of the frameworks. Therefore, the bi-input+RetinaNet+C-LSTM framework had the best performance when compared to that of the other frameworks. Our study demonstrates that our system can assist physicians in detecting intracranial aneurysms on 2D DSA images. ",
doi="10.2196/28880",
url="https://medinform.jmir.org/2022/3/e28880",
url="http://www.ncbi.nlm.nih.gov/pubmed/35294371"
}


@Article{info:doi/10.2196/30587,
author="Nam, Borum
and Kim, Young Joo
and Kim, Young In
and Cho, Hwan Baek",
title="Selective Prediction With Long Short-term Memory Using Unit-Wise Batch Standardization for Time Series Health Data Sets: Algorithm Development and Validation",
journal="JMIR Med Inform",
year="2022",
month="Mar",
day="15",
volume="10",
number="3",
pages="e30587",
keywords="artificial intelligence",
keywords="recurrent neural networks",
keywords="biomedical informatics",
keywords="computer-aided analysis",
keywords="mobile phone",
abstract="Background: In any health care system, both the classification of data and the confidence level of such classifications are important. Therefore, a selective prediction model is required to classify time series health data according to confidence levels of prediction. Objective: This study aims to develop a method using long short-term memory (LSTM) models with a reject option for time series health data classification. Methods: An existing selective prediction method was adopted to implement an option for rejecting a classification output in LSTM models. However, a conventional selection function approach to LSTM does not achieve acceptable performance during learning stages. To tackle this problem, we proposed a unit-wise batch standardization that attempts to normalize each hidden unit in LSTM to apply the structural characteristics of LSTM models that concern the selection function. Results: The ability of our method to approximate the target confidence level was compared by coverage violations for 2 time series of health data sets consisting of human activity and arrhythmia. For both data sets, our approach yielded lower average coverage violations (0.98\% and 1.79\% for each data set) than those of the conventional approach. In addition, the classification performance when using the reject option was compared with that of other normalization methods. Our method demonstrated superior performance for selective risk (12.63\% and 17.82\% for each data set), false-positive rates (2.09\% and 5.8\% for each data set), and false-negative rates (10.58\% and 17.24\% for each data set). Conclusions: Our normalization approach can help make selective predictions for time series health data. We expect this technique to enhance the confidence of users in classification systems and improve collaborative efforts between humans and artificial intelligence in the medical field through the use of classification that considers confidence. ",
doi="10.2196/30587",
url="https://medinform.jmir.org/2022/3/e30587",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289753"
}


@Article{info:doi/10.2196/28333,
author="Ferrario, Andrea
and Luo, Minxia
and Polsinelli, J. Angelina
and Moseley, A. Suzanne
and Mehl, R. Matthias
and Yordanova, Kristina
and Martin, Mike
and Demiray, Burcu",
title="Predicting Working Memory in Healthy Older Adults Using Real-Life Language and Social Context Information: A Machine Learning Approach",
journal="JMIR Aging",
year="2022",
month="Mar",
day="8",
volume="5",
number="1",
pages="e28333",
keywords="cognitive aging",
keywords="language complexity",
keywords="social context",
keywords="machine learning",
keywords="natural language processing",
keywords="Electronically Activated Recorder (EAR)",
keywords="behavioral indicators",
abstract="Background: Language use and social interactions have demonstrated a close relationship with cognitive measures. It is important to improve the understanding of language use and behavioral indicators from social context to study the early prediction of cognitive decline among healthy populations of older adults. Objective: This study aimed at predicting an important cognitive ability, working memory, of 98 healthy older adults participating in a 4-day-long naturalistic observation study. We used linguistic measures, part-of-speech (POS) tags, and social context information extracted from 7450 real-life audio recordings of their everyday conversations. Methods: The methods in this study comprise (1) the generation of linguistic measures, representing idea density, vocabulary richness, and grammatical complexity, as well as POS tags with natural language processing (NLP) from the transcripts of real-life conversations and (2) the training of machine learning models to predict working memory using linguistic measures, POS tags, and social context information. We measured working memory using (1) the Keep Track test, (2) the Consonant Updating test, and (3) a composite score based on the Keep Track and Consonant Updating tests. We trained machine learning models using random forest, extreme gradient boosting, and light gradient boosting machine algorithms, implementing repeated cross-validation with different numbers of folds and repeats and recursive feature elimination to avoid overfitting. Results: For all three prediction routines, models comprising linguistic measures, POS tags, and social context information improved the baseline performance on the validation folds. The best model for the Keep Track prediction routine comprised linguistic measures, POS tags, and social context variables. The best models for prediction of the Consonant Updating score and the composite working memory score comprised POS tags only. Conclusions: The results suggest that machine learning and NLP may support the prediction of working memory using, in particular, linguistic measures and social context information extracted from the everyday conversations of healthy older adults. Our findings may support the design of an early warning system to be used in longitudinal studies that collects cognitive ability scores and records real-life conversations unobtrusively. This system may support the timely detection of early cognitive decline. In particular, the use of a privacy-sensitive passive monitoring technology would allow for the design of a program of interventions to enable strategies and treatments to decrease or avoid early cognitive decline. ",
doi="10.2196/28333",
url="https://aging.jmir.org/2022/1/e28333",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258457"
}


@Article{info:doi/10.2196/34475,
author="Kalafatis, Chris
and Modarres, Hadi Mohammad
and Apostolou, Panos
and Tabet, Naji
and Khaligh-Razavi, Seyed-Mahdi",
title="The Use of a Computerized Cognitive Assessment to Improve the Efficiency of Primary Care Referrals to Memory Services: Protocol for the Accelerating Dementia Pathway Technologies (ADePT) Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="27",
volume="11",
number="1",
pages="e34475",
keywords="primary health care",
keywords="general practice",
keywords="dementia",
keywords="cognitive assessment",
keywords="artificial intelligence",
keywords="early diagnosis",
keywords="cognition",
keywords="assessment",
keywords="efficiency",
keywords="diagnosis",
keywords="COVID-19",
keywords="memory",
keywords="mental health",
keywords="impairment",
keywords="screening",
keywords="detection",
abstract="Background: Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerized cognitive tests, such as the Integrated Cognitive Assessment (ICA), as prominent candidates for adoption in clinical practice both during the pandemic and for post-COVID-19 implementation as part of health care innovation. Objective: The aim of the Accelerating Dementia Pathway Technologies (ADePT) study is to develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment to improve the efficiency of the dementia care pathway. Methods: Patients who have been referred to a memory clinic by a general practitioner (GP) are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as National Health Service reference costing data will be used to assess the potential health and economic benefits of the use of the ICA in the dementia diagnosis pathway. Results: The ADePT study was funded in January 2020 by Innovate UK (Project Number 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially, the study was designed for in-person visits at the memory clinic; however, in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. Conclusions: The ADePT study aims to improve the efficiency of the dementia care pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardized, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision support system that can signpost accordingly can reduce unnecessary referrals, service backlog, and assessment variability. Trial Registration: ISRCTN 16596456; https://www.isrctn.com/ISRCTN16596456 International Registered Report Identifier (IRRID): DERR1-10.2196/34475 ",
doi="10.2196/34475",
url="https://www.researchprotocols.org/2022/1/e34475",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932495"
}


@Article{info:doi/10.2196/31053,
author="van Gils, M. Aniek
and Visser, NC Leonie
and Hendriksen, MA Heleen
and Georges, Jean
and Muller, Majon
and Bouwman, H. Femke
and van der Flier, M. Wiesje
and Rhodius-Meester, FM Hanneke",
title="Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="3",
volume="5",
number="12",
pages="e31053",
keywords="artificial intelligence",
keywords="clinical decision support systems",
keywords="dementia",
keywords="diagnostic testing",
keywords="diagnosis",
keywords="prognosis",
keywords="communication",
abstract="Background: Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis. Objective: This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners. Methods: Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer's Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6\% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer's Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34\% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54\% female) participated in this survey. Results: Most clinicians reported a willingness to use diagnostic (88/109, 80.7\%) and prognostic (83/109, 76.1\%) computer tools. User-friendliness (71/109, 65.1\%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7\%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2\%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44\%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72\%) and prognosis (73/96, 76\%). In addition, most of them thought favorably regarding the possibility of using the tools themselves. Conclusions: This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity. ",
doi="10.2196/31053",
url="https://formative.jmir.org/2021/12/e31053",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870612"
}


@Article{info:doi/10.2196/27036,
author="Zhang, Bo
and Robb, Nigel",
title="Immersion Experiences in a Tablet-Based Markerless Augmented Reality Working Memory Game: Randomized Controlled Trial and User Experience Study",
journal="JMIR Serious Games",
year="2021",
month="Oct",
day="12",
volume="9",
number="4",
pages="e27036",
keywords="augmented reality",
keywords="markerless augmented reality",
keywords="immersion experience",
keywords="cognitive training games",
keywords="working memory",
keywords="markerless augmented reality n-back game",
abstract="Background: In recent years, augmented reality (AR), especially markerless augmented reality (MAR), has been used more prevalently to create training games in an attempt to improve humans' cognitive functions. This has been driven by studies claiming that MAR provides users with more immersive experiences that are situated in the real world. Currently, no studies have scientifically investigated the immersion experience of users in a MAR cognitive training game. Moreover, there is an observed lack of instruments on measuring immersion in MAR cognitive training games. Objective: This study, using two existing immersion questionnaires, investigates students' immersion experiences in a novel MAR n-back game. Methods: The n-back task is a continuous performance task that taps working memory (WM) capacity. We compared two versions of n-back training. One was presented in a traditional 2D format, while the second version used MAR. There were 2 experiments conducted in this study that coordinated with 2 types of immersion questionnaires: the modified Immersive Experiences Questionnaire (IEQ) and the Augmented Reality Immersion (ARI) questionnaire. Two groups of students from two universities in China joined the study, with 60 participants for the first experiment (a randomized controlled experiment) and 51 participants for the second. Results: Both groups of students experienced immersion in the MAR n-back game. However, the MAR n-back training group did not experience stronger immersion than the traditional (2D) n-back control group in the first experiment. The results of the second experiment showed that males felt deeply involved with the AR environment, which resulted in obtaining higher levels of immersion than females in the MAR n-back game. Conclusions: Both groups of students experienced immersion in the MAR n-back game. Moreover, both the modified IEQ and ARI have the potential to be used as instruments to measure immersion in MAR game settings. Trial Registration: UMIN Clinical Trials Registry UMIN000045314; https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000051725 ",
doi="10.2196/27036",
url="https://games.jmir.org/2021/4/e27036",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636738"
}


@Article{info:doi/10.2196/29433,
author="Du, Yi
and Wang, Hanxue
and Cui, Wenjuan
and Zhu, Hengshu
and Guo, Yunchang
and Dharejo, Ali Fayaz
and Zhou, Yuanchun",
title="Foodborne Disease Risk Prediction Using Multigraph Structural Long Short-term Memory Networks: Algorithm Design and Validation Study",
journal="JMIR Med Inform",
year="2021",
month="Aug",
day="2",
volume="9",
number="8",
pages="e29433",
keywords="foodborne disease",
keywords="risk",
keywords="prediction",
keywords="spatial--temporal data",
abstract="Background: Foodborne disease is a common threat to human health worldwide, leading to millions of deaths every year. Thus, the accurate prediction foodborne disease risk is very urgent and of great importance for public health management. Objective: We aimed to design a spatial--temporal risk prediction model suitable for predicting foodborne disease risks in various regions, to provide guidance for the prevention and control of foodborne diseases. Methods: We designed a novel end-to-end framework to predict foodborne disease risk by using a multigraph structural long short-term memory neural network, which can utilize an encoder--decoder to achieve multistep prediction. In particular, to capture multiple spatial correlations, we divided regions by administrative area and constructed adjacent graphs with metrics that included region proximity, historical data similarity, regional function similarity, and exposure food similarity. We also integrated an attention mechanism in both spatial and temporal dimensions, as well as external factors, to refine prediction accuracy. We validated our model with a long-term real-world foodborne disease data set, comprising data from 2015 to 2019 from multiple provinces in China. Results: Our model can achieve F1 scores of 0.822, 0.679, 0.709, and 0.720 for single-month forecasts for the provinces of Beijing, Zhejiang, Shanxi and Hebei, respectively, and the highest F1 score was 20\% higher than the best results of the other models. The experimental results clearly demonstrated that our approach can outperform other state-of-the-art models, with a margin. Conclusions: The spatial--temporal risk prediction model can take into account the spatial--temporal characteristics of foodborne disease data and accurately determine future disease spatial--temporal risks, thereby providing support for the prevention and risk assessment of foodborne disease. ",
doi="10.2196/29433",
url="https://medinform.jmir.org/2021/8/e29433",
url="http://www.ncbi.nlm.nih.gov/pubmed/34338648"
}


@Article{info:doi/10.2196/30514,
author="O'Loughlin, Patricia
and Pavithra, Pavithra
and Regan, John
and Bennett, Marc
and Knight, Rachel
and Lenaert, Bert
and Marquez, Melissa
and Taddeo, Michelle
and Griffith, James
and Shapiro, Rita
and Farina, Francesca",
title="A Randomized Controlled Trial Investigating the Feasibility of a Low-Intensity Psychological Intervention for Fear of Memory Loss and Quality of Life in Older Adults: Protocol for the Reducing Fear and Avoidance of Memory Loss (REFRAME) Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="30",
volume="10",
number="7",
pages="e30514",
keywords="fear",
keywords="memory loss",
keywords="dementia",
keywords="older adults",
keywords="mindfulness",
keywords="behavioral activation",
abstract="Background: Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective: We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods: Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results: Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions: Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration: ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID): PRR1-10.2196/30514 ",
doi="10.2196/30514",
url="https://www.researchprotocols.org/2021/7/e30514",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328428"
}


@Article{info:doi/10.2196/17551,
author="Bayen, Eleonore
and Nickels, Shirley
and Xiong, Glen
and Jacquemot, Julien
and Subramaniam, Raghav
and Agrawal, Pulkit
and Hemraj, Raheema
and Bayen, Alexandre
and Miller, L. Bruce
and Netscher, George",
title="Reduction of Time on the Ground Related to Real-Time Video Detection of Falls in Memory Care Facilities: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="17",
volume="23",
number="6",
pages="e17551",
keywords="artificial intelligence",
keywords="video monitoring",
keywords="real-time video detection",
keywords="fall",
keywords="time on the ground",
keywords="Alzheimer disease",
keywords="dementia",
keywords="memory care facilities",
abstract="Background: Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. Objective: This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. Methods: SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. Results: A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80\% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1\% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6\% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31\% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6\% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3\% (78/141) of them spent less than 10 minutes on the ground. Conclusions: SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs. ",
doi="10.2196/17551",
url="https://www.jmir.org/2021/6/e17551",
url="http://www.ncbi.nlm.nih.gov/pubmed/34137723"
}


@Article{info:doi/10.2196/25233,
author="Mogle, Jacqueline
and Hill, L. Nikki
and Turner, R. Jennifer",
title="Individual Differences and Features of Self-reported Memory Lapses as Risk Factors for Alzheimer Disease Among Adults Aged 50 Years and Older: Protocol for a Coordinated Analysis Across Two Longitudinal Data Sets",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="14",
volume="10",
number="5",
pages="e25233",
keywords="subjective memory",
keywords="individual differences",
keywords="Alzheimer disease",
keywords="daily assessment",
keywords="multilevel modeling",
keywords="coordinated analysis",
keywords="mobile phone",
abstract="Background: Increasing evidence has promoted the clinical utility of self-reported memory problems for detecting early impairment associated with Alzheimer disease (AD). However, previous studies investigating memory problems often conflated the types of problems (ie, retrospective and prospective) with their features (ie, frequency and consequences). This bias limits the specificity of traditional measures of memory problems and minimizes their ability to detect differential trajectories associated with cognitive decline. In this study, we use a novel measure of self-reported memory problems that uses daily reports of memory lapses to disentangle types from features for analyzing the impact of each dimension in two longitudinal data sets. Furthermore, this study explores the individual difference factors of age and gender as potential moderators of the relationships between self-reported memory lapses and objective cognitive decline. Objective: The aim of this study is to describe the protocol for a secondary data analysis project that explores the relationship between experiences of daily memory lapses and their associations with cognitive decline in middle-aged and older adults. Methods: This study uses multilevel, coordinated analyses across two measurement burst data sets to examine the links between features and consequences of memory lapses (retrospective and prospective) and their association with objective cognitive decline. This study's sample (N=392; aged 50-85 years; n=254, 64.8\% women) is drawn from two ongoing, nationally funded research studies: The Effects of Stress on Cognitive Aging, Physiology, and Emotion study and the Einstein Aging Study. Both studies assess the daily experience of memory lapses, including the type as well as the emotional and functional outcomes, and objective measures of cognition, such as processing speed and episodic memory. We will use multilevel modeling to test our conceptual model demonstrating that differences in frequency and types of memory lapses show differential trends in their relationships with cognitive decline and that these relationships vary by the age and gender of participants. Results: This project was funded in August 2019. The approval for secondary data analysis was given by the institutional review board in February 2020. Data analysis for this project has not yet started. Conclusions: The early and accurate identification of individuals most at risk for cognitive decline is of paramount importance. Previous research exploring self-reported memory problems and AD is promising; however, limitations in measurement may explain previous reports of inconsistences. This study addresses these concerns by examining daily reports of memory lapses, how these vary by age and gender, and their relationship with objective cognitive performance. Overall, this study aims to identify the key features of daily memory lapses and the differential trajectories that best predict cognitive decline to help inform future AD risk screening tools. International Registered Report Identifier (IRRID): DERR1-10.2196/25233 ",
doi="10.2196/25233",
url="https://www.researchprotocols.org/2021/5/e25233",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988514"
}


@Article{info:doi/10.2196/18803,
author="Liu, Xiaoli
and Liu, Tongbo
and Zhang, Zhengbo
and Kuo, Po-Chih
and Xu, Haoran
and Yang, Zhicheng
and Lan, Ke
and Li, Peiyao
and Ouyang, Zhenchao
and Ng, Lam Yeuk
and Yan, Wei
and Li, Deyu",
title="TOP-Net Prediction Model Using Bidirectional Long Short-term Memory and Medical-Grade Wearable Multisensor System for Tachycardia Onset: Algorithm Development Study",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="15",
volume="9",
number="4",
pages="e18803",
keywords="tachycardia onset",
keywords="early prediction",
keywords="deep neural network",
keywords="wearable monitoring system",
keywords="electronic health record",
abstract="Background: Without timely diagnosis and treatment, tachycardia, also called tachyarrhythmia, can cause serious complications such as heart failure, cardiac arrest, and even death. The predictive performance of conventional clinical diagnostic procedures needs improvement in order to assist physicians in detecting risk early on. Objective: We aimed to develop a deep tachycardia onset prediction (TOP-Net) model based on deep learning (ie, bidirectional long short-term memory) for early tachycardia diagnosis with easily accessible data. Methods: TOP-Net leverages 2 easily accessible data sources: vital signs, including heart rate, respiratory rate, and blood oxygen saturation (SpO2) acquired continuously by wearable embedded systems, and electronic health records, containing age, gender, admission type, first care unit, and cardiovascular disease history. The model was trained with a large data set from an intensive care unit and then transferred to a real-world scenario in the general ward. In this study, 3 experiments incorporated merging patients' personal information, temporal memory, and different feature combinations. Six metrics (area under the receiver operating characteristic curve [AUROC], sensitivity, specificity, accuracy, F1 score, and precision) were used to evaluate predictive performance. Results: TOP-Net outperformed the baseline models on the large critical care data set (AUROC 0.796, 95\% CI 0.768-0.824; sensitivity 0.753, 95\% CI 0.663-0.793; specificity 0.720, 95\% CI 0.645-0.758; accuracy 0.721; F1 score 0.718; precision 0.686) when predicting tachycardia onset 6 hours in advance. When predicting tachycardia onset 2 hours in advance with data acquired from our hospital using the transferred TOP-Net, the 6 metrics were 0.965, 0.955, 0.881, 0.937, 0.793, and 0.680, respectively. The best performance was achieved using comprehensive vital signs (heart rate, respiratory rate, and SpO2) statistical information. Conclusions: TOP-Net is an early tachycardia prediction model that uses 8 types of data from wearable sensors and electronic health records. When validated in clinical scenarios, the model achieved a prediction performance that outperformed baseline models 0 to 6 hours before tachycardia onset in the intensive care unit and 2 hours before tachycardia onset in the general ward. Because of the model's implementation and use of easily accessible data from wearable sensors, the model can assist physicians with early discovery of patients at risk in general wards and houses. ",
doi="10.2196/18803",
url="https://medinform.jmir.org/2021/4/e18803",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856350"
}


@Article{info:doi/10.2196/20177,
author="Kim, Jeongsim
and Shin, EunJi
and Han, KyungHwa
and Park, Soowon
and Youn, Hae Jung
and Jin, Guixiang
and Lee, Jun-Young",
title="Efficacy of Smart Speaker--Based Metamemory Training in Older Adults: Case-Control Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="16",
volume="23",
number="2",
pages="e20177",
keywords="smart speaker",
keywords="cognitive training",
keywords="cognitive decline",
abstract="Background: Metamemory training (MMT) is a useful training strategy for improving cognitive functioning in the older adult population. Despite the advantages, there are limitations imposed by location and time constraints. Objective: This study aimed to develop a smart speaker--based MMT program and evaluate the efficacy of the program in older adults without cognitive impairment. Methods: This study used a case-control cohort design. The smart speaker--based MMT program comprised 3 training sessions per day, 5 days a week, for 8 weeks. Each training session took approximately 15 minutes. This program was implemented using smart speakers, not human trainers. All participants completed the Mini-Mental State Examination, Subjective Memory Complaints Questionnaire, Verbal Learning Test, Digit Span Test, fluency tests, and a short-form version of the Geriatric Depression Scale before and after training. Results: A total of 60 subjects (29 in the MMT group and 31 in the control group) participated in the study. The training group showed significant increases in the delayed free recall, digit span forward, digit span backward, and fluency test scores compared with the control group. Conclusions: This study confirmed the efficacy of smart speaker--based MMT in older adults. Home-based smart speaker--based MMT is not limited with respect to location or constrained by space and may help older adults with subjective cognitive decline without requiring intervention by human professionals. ",
doi="10.2196/20177",
url="http://www.jmir.org/2021/2/e20177/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591276"
}


@Article{info:doi/10.2196/19244,
author="Sturge, Jodi
and Meijering, Louise
and Jones, Allyson C.
and Garvelink, Mirjam
and Caron, Danielle
and Nordin, Susanna
and Elf, Marie
and L{\'e}gar{\'e}, France",
title="Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="21",
volume="10",
number="1",
pages="e19244",
keywords="aging in place",
keywords="co-design",
keywords="cross-country comparison",
keywords="electronic decision support intervention",
keywords="housing decisions",
keywords="memory problems",
keywords="mixed methods",
keywords="mobility patterns",
keywords="shared decision making",
keywords="technology",
abstract="Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users' mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults' autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 ",
doi="10.2196/19244",
url="http://www.researchprotocols.org/2021/1/e19244/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33475512"
}


@Article{info:doi/10.2196/15913,
author="Monkman, Helen
and Kushniruk, W. Andre
and Borycki, M. Elizabeth
and Sheets, J. Debra
and Barnett, Jeffrey",
title="Differences in Memory, Perceptions, and Preferences of Multimedia Consumer Medication Information: Experimental Performance and Self-Report Study",
journal="JMIR Hum Factors",
year="2020",
month="Dec",
day="1",
volume="7",
number="4",
pages="e15913",
keywords="consumer medication information",
keywords="medication guides",
keywords="patient medication information",
keywords="prescription drug information leaflet",
keywords="patient information leaflets",
keywords="multimedia learning",
keywords="health literacy",
keywords="eHealth literacy",
keywords="consumer health informatics",
keywords="cognitive theory of multimedia learning",
abstract="Background: Electronic health resources are becoming prevalent. However, consumer medication information (CMI) is still predominantly text based. Incorporating multimedia into CMI (eg, images, narration) may improve consumers' memory of the information as well as their perceptions and preferences of these materials. Objective: This study examined whether adding images and narration to CMI impacted patients' (1) memory, (2) perceptions of comprehensibility, utility, or design quality, and (3) overall preferences. Methods: We presented 36 participants with CMI in 3 formats: (1) text, (2) text + images, and (3) narration + images, and subsequently asked them to recall information. After seeing all 3 CMI formats, participants rated the formats in terms of comprehensibility, utility, and design quality, and ranked them from most to least favorite. Results: Interestingly, no significant differences in memory were observed (F2,70=0.1, P=0.901). Thus, this study did not find evidence to support multimedia or modality principles in the context of CMI. Despite the absence of effects on memory, the CMI format significantly impacted perceptions of the materials. Specifically, participants rated the text + images format highest in terms of comprehensibility ($\chi$22=26.5, P<.001) and design quality ($\chi$22=35.69, P<.001). Although the omnibus test suggested a difference in utility ratings as well ($\chi$22=8.21, P=.016), no significant differences were found after correcting for multiple comparisons. Consistent with perception findings, the preference ranks yielded a significant difference ($\chi$22=26.00, P<.001), whereby participants preferred the text + images format overall. Indeed, 75\% (27/36) of participants chose the text + images format as their most favorite. Thus, although there were no objective memory differences between the formats, we observed subjective differences in comprehensibility, design quality, and overall preferences. Conclusions: This study revealed that although multimedia did not appear to influence memory of CMI, it did impact participants' opinions about the materials. The lack of observed differences in memory may have been due to ceiling effects, memory rather than understanding as an index of learning, the fragmented nature of the information in CMI itself, or the size or characteristics of the sample (ie, young, educated subjects with adequate health literacy skills). The differences in the subjective (ie, perceptions and preferences) and objective (ie, memory) results highlight the value of using both types of measures. Moreover, findings from this study could be used to inform future research on how CMI could be designed to better suit the preferences of consumers and potentially increase the likelihood that CMI is used. Additional research is warranted to explore whether multimedia impacts memory of CMI under different conditions (eg, older participants, subjects with lower levels of health literacy, more difficult stimuli, or extended time for decay). ",
doi="10.2196/15913",
url="http://humanfactors.jmir.org/2020/4/e15913/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33258780"
}


@Article{info:doi/10.2196/20620,
author="Jones, Chelsea
and Smith-MacDonald, Lorraine
and Miguel-Cruz, Antonio
and Pike, Ashley
and van Gelderen, Marieke
and Lentz, Liana
and Shiu, Y. Maria
and Tang, Emily
and Sawalha, Jeffrey
and Greenshaw, Andrew
and Rhind, G. Shawn
and Fang, Xin
and Norbash, Adrian
and Jetly, Rakesh
and Vermetten, Eric
and Br{\'e}mault-Phillips, Suzette",
title="Virtual Reality--Based Treatment for Military Members and Veterans With Combat-Related Posttraumatic Stress Disorder: Protocol for a Multimodular Motion-Assisted Memory Desensitization and Reconsolidation Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Oct",
day="29",
volume="9",
number="10",
pages="e20620",
keywords="3MDR",
keywords="posttraumatic stress disorder",
keywords="military",
keywords="veteran",
keywords="psychotherapy",
keywords="virtual reality",
abstract="Background: Military members are at elevated risk of operational stress injuries, including posttraumatic stress disorder (PTSD) and moral injury. Although psychotherapy can reduce symptoms, some military members may experience treatment-resistant PTSD. Multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has been introduced as a virtual reality (VR) intervention for military members with PTSD related to military service. The 3MDR intervention incorporates exposure therapy, psychotherapy, eye movement desensitization and reconsolidation, VR, supportive counselling, and treadmill walking. Objective: The objective of this study is to investigate whether 3MDR reduces PTSD symptoms among military members with combat-related treatment-resistant PTSD (TR-PTSD); examine the technology acceptance and usability of the Computer Assisted Rehabilitation ENvironment (CAREN) and 3MDR interventions by Canadian Armed Forces service members (CAF-SMs), veterans, 3MDR clinicians, and operators; and evaluate the impact on clinicians and operators of delivering 3MDR. Methods: This is a mixed-methods waitlist controlled crossover design randomized controlled trial. Participants include both CAF-SMs and veterans (N=40) aged 18-60 years with combat-related TR-PTSD (unsuccessful experience of at least 2 evidence-based trauma treatments). Participants will also include clinicians and operators (N=12) who have been trained in 3MDR and subsequently utilized this intervention with patients. CAF-SMs and veterans will receive 6 weekly 90-minute 3MDR sessions. Quantitative and qualitative data will be collected at baseline and at 1, 3, and 6 months postintervention. Quantitative data collection will include multiomic biomarkers (ie, blood and salivary proteomic and genomic profiles of neuroendocrine, immune-inflammatory mediators, and microRNA), eye tracking, electroencephalography, and physiological data. Data from outcome measures will capture self-reported symptoms of PTSD, moral injury, resilience, and technology acceptance and usability. Qualitative data will be collected from audiovisual recordings of 3MDR sessions and semistructured interviews. Data analysis will include univariate and multivariate approaches, and thematic analysis of treatment sessions and interviews. Machine learning analysis will be included to develop models for the prediction of diagnosis, symptom severity, and treatment outcomes. Results: This study commenced in April 2019 and is planned to conclude in April 2021. Study results will guide the further evolution and utilization of 3MDR for military members with TR-PTSD and will have utility in treating other trauma-affected populations. Conclusions: The goal of this study is to utilize qualitative and quantitative primary and secondary outcomes to provide evidence for the effectiveness and feasibility of 3MDR for treating CAF-SMs and veterans with combat-related TR-PTSD. The results will inform a full-scale clinical trial and stimulate development and adaptation of the protocol to mobile VR apps in supervised clinical settings. This study will add to knowledge of the clinical effectiveness of 3MDR, and provide the first comprehensive analysis of biomarkers, technology acceptance and usability, moral injury, resilience, and the experience of clinicians and operators delivering 3MDR. Trial Registration: ISRCTN Registry 11264368; http://www.isrctn.com/ISRCTN11264368. International Registered Report Identifier (IRRID): DERR1-10.2196/20620 ",
doi="10.2196/20620",
url="http://www.researchprotocols.org/2020/10/e20620/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118957"
}


@Article{info:doi/10.2196/19848,
author="Li, Yongbin
and Wang, Xiaohua
and Hui, Linhu
and Zou, Liping
and Li, Hongjin
and Xu, Luo
and Liu, Weihai",
title="Chinese Clinical Named Entity Recognition in Electronic Medical Records: Development of a Lattice Long Short-Term Memory Model With Contextualized Character Representations",
journal="JMIR Med Inform",
year="2020",
month="Sep",
day="4",
volume="8",
number="9",
pages="e19848",
keywords="clinical named entity recognition",
keywords="ELMo",
keywords="lattice LSTM",
keywords="deep learning",
keywords="neural network",
keywords="sequence tagging",
abstract="Background: Clinical named entity recognition (CNER), whose goal is to automatically identify clinical entities in electronic medical records (EMRs), is an important research direction of clinical text data mining and information extraction. The promotion of CNER can provide support for clinical decision making and medical knowledge base construction, which could then improve overall medical quality. Compared with English CNER, and due to the complexity of Chinese word segmentation and grammar, Chinese CNER was implemented later and is more challenging. Objective: With the development of distributed representation and deep learning, a series of models have been applied in Chinese CNER. Different from the English version, Chinese CNER is mainly divided into character-based and word-based methods that cannot make comprehensive use of EMR information and cannot solve the problem of ambiguity in word representation. Methods: In this paper, we propose a lattice long short-term memory (LSTM) model combined with a variant contextualized character representation and a conditional random field (CRF) layer for Chinese CNER: the Embeddings from Language Models (ELMo)-lattice-LSTM-CRF model. The lattice LSTM model can effectively utilize the information from characters and words in Chinese EMRs; in addition, the variant ELMo model uses Chinese characters as input instead of the character-encoding layer of the ELMo model, so as to learn domain-specific contextualized character embeddings. Results: We evaluated our method using two Chinese CNER datasets from the China Conference on Knowledge Graph and Semantic Computing (CCKS): the CCKS-2017 CNER dataset and the CCKS-2019 CNER dataset. We obtained F1 scores of 90.13\% and 85.02\% on the test sets of these two datasets, respectively. Conclusions: Our results show that our proposed method is effective in Chinese CNER. In addition, the results of our experiments show that variant contextualized character representations can significantly improve the performance of the model. ",
doi="10.2196/19848",
url="http://medinform.jmir.org/2020/9/e19848/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32885786"
}


@Article{info:doi/10.2196/16533,
author="Nasseh, Daniel
and Schneiderbauer, Sophie
and Lange, Michael
and Schweizer, Diana
and Heinemann, Volker
and Belka, Claus
and Cadenovic, Ranko
and Buysse, Laurence
and Erickson, Nicole
and Mueller, Michael
and Kortuem, Karsten
and Niyazi, Maximilian
and Marschner, Sebastian
and Fey, Theres",
title="Optimizing the Analytical Value of Oncology-Related Data Based on an In-Memory Analysis Layer: Development and Assessment of the Munich Online Comprehensive Cancer Analysis Platform",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="17",
volume="22",
number="4",
pages="e16533",
keywords="oncology",
keywords="database management systems",
keywords="data visualization",
keywords="usability",
abstract="Background: Many comprehensive cancer centers incorporate tumor documentation software supplying structured information from the associated centers' oncology patients for internal and external audit purposes.  However, much of the documentation data included in these systems often remain unused and unknown by most of the clinicians at the sites. Objective: To improve access to such data for analytical purposes, a prerollout of an analysis layer based on the business intelligence software QlikView was implemented. This software allows for the real-time analysis and inspection of oncology-related data. The system is meant to increase access to the data while simultaneously providing tools for user-friendly real-time analytics. Methods: The system combines in-memory capabilities (based on QlikView software) with innovative techniques that compress the complexity of the data, consequently improving its readability as well as its accessibility for designated end users. Aside from the technical and conceptual components, the software's implementation necessitated a complex system of permission and governance. Results: A continuously running system including daily updates with a user-friendly Web interface and real-time usage was established. This paper introduces its main components and major design ideas.  A commented video summarizing and presenting the work can be found within the Multimedia Appendix. Conclusions: The system has been well-received by a focus group of physicians within an initial prerollout. Aside from improving data transparency, the system's main benefits are its quality and process control capabilities, knowledge discovery, and hypothesis generation. Limitations such as run time, governance, or misinterpretation of data are considered. ",
doi="10.2196/16533",
url="https://www.jmir.org/2020/4/e16533",
url="http://www.ncbi.nlm.nih.gov/pubmed/32077858"
}


@Article{info:doi/10.2196/14809,
author="Timimi, Farris
and Ray, Sara
and Jones, Erik
and Aase, Lee
and Hoffman, Kathleen",
title="Patient-Reported Outcomes in Online Communications on Statins, Memory, and Cognition: Qualitative Analysis Using Online Communities",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="28",
volume="21",
number="11",
pages="e14809",
keywords="social media",
keywords="hydroxymethylglutaryl-CoA reductase inhibitors",
keywords="drug-related side effects and adverse reactions",
keywords="memory loss",
keywords="PROMs",
keywords="pharmacovigilance",
keywords="infodemiology",
keywords="infoveillance",
keywords="peer-support groups",
abstract="Background: In drug development clinical trials, there is a need for balance between restricting variables by setting eligibility criteria and representing the broader patient population that may use a product once it is approved. Similarly, although recent policy initiatives focusing on the inclusion of historically underrepresented groups are being implemented, barriers still remain. These limitations of clinical trials may mask potential product benefits and side effects. To bridge these gaps, online communication in health communities may serve as an additional population signal for drug side effects. Objective: The aim of this study was to employ a nontraditional dataset to identify drug side-effect signals. The study was designed to apply both natural language processing (NLP) technology and hands-on linguistic analysis to a set of online posts from known statin users to (1) identify any underlying crossover between the use of statins and impairment of memory or cognition and (2) obtain patient lexicon in their descriptions of experiences with statin medications and memory changes. Methods: Researchers utilized user-generated content on Inspire, looking at over 11 million posts across Inspire. Posts were written by patients and caregivers belonging to a variety of communities on Inspire. After identifying these posts, researchers used NLP and hands-on linguistic analysis to draw and expand upon correlations among statin use, memory, and cognition. Results: NLP analysis of posts identified statistical correlations between statin users and the discussion of memory impairment, which were not observed in control groups. NLP found that, out of all members on Inspire, 3.1\% had posted about memory or cognition. In a control group of those who had posted about TNF inhibitors, 6.2\% had also posted about memory and cognition. In comparison, of all those who had posted about a statin medication, 22.6\% (P<.001) also posted about memory and cognition. Furthermore, linguistic analysis of a sample of posts provided themes and context to these statistical findings. By looking at posts from statin users about memory, four key themes were found and described in detail in the data: memory loss, aphasia, cognitive impairment, and emotional change. Conclusions: Correlations from this study point to a need for further research on the impact of statins on memory and cognition. Furthermore, when using nontraditional datasets, such as online communities, NLP and linguistic methodologies broaden the population for identifying side-effect signals. For side effects such as those on memory and cognition, where self-reporting may be unreliable, these methods can provide another avenue to inform patients, providers, and the Food and Drug Administration. ",
doi="10.2196/14809",
url="http://www.jmir.org/2019/11/e14809/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31778117"
}


@Article{info:doi/10.2196/13887,
author="Ijaz, Kiran
and Ahmadpour, Naseem
and Naismith, L. Sharon
and Calvo, A. Rafael",
title="An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study",
journal="JMIR Ment Health",
year="2019",
month="Sep",
day="03",
volume="6",
number="9",
pages="e13887",
keywords="virtual reality",
keywords="healthy aging",
keywords="memory",
keywords="cognition",
keywords="dementia",
abstract="Background: Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements. Objective: This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC). Methods: VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup. Results: Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87). Conclusions: The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future. ",
doi="10.2196/13887",
url="https://mental.jmir.org/2019/9/e13887/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31482851"
}


@Article{info:doi/10.2196/13378,
author="McCarron, R. Hayley
and Zmora, Rachel
and Gaugler, E. Joseph",
title="A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial",
journal="JMIR Aging",
year="2019",
month="Jun",
day="18",
volume="2",
number="1",
pages="e13378",
keywords="Alzheimer disease",
keywords="dementia",
keywords="social support",
keywords="quality of life",
keywords="well-being",
keywords="technology",
keywords="social engagement",
keywords="facial recognition",
keywords="smartwatch",
abstract="Background: It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement. Objective: This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs. Methods: Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey. Results: Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations. Conclusions: There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation. Trial Registration: ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq) ",
doi="10.2196/13378",
url="http://aging.jmir.org/2019/1/e13378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518270"
}


@Article{info:doi/10.2196/13333,
author="Martens, Kris
and Takano, Keisuke
and Barry, J. Tom
and Goedleven, Jolien
and Van den Meutter, Louise
and Raes, Filip",
title="Remediating Reduced Autobiographical Memory in Healthy Older Adults With Computerized Memory Specificity Training (c-MeST): An Observational Before-After Study",
journal="J Med Internet Res",
year="2019",
month="May",
day="14",
volume="21",
number="5",
pages="e13333",
keywords="memory specificity training",
keywords="autobiographical memory",
keywords="cognitive aging",
keywords="online",
keywords="depression",
keywords="memory",
keywords="telemedicine",
keywords="rumination, cognitive",
abstract="Background: The ability to retrieve specific autobiographical memories decreases with cognitive aging. This decline is clinically relevant due to its association with impairments in problem solving, daily functioning, and depression. A therapist-delivered group training protocol, Memory Specificity Training (MeST), has been shown to enhance the retrieval of specific memories while ameliorating the impairments and negative outcomes associated with reduced specificity. The therapist-delivered nature of this intervention means it is relatively expensive to deliver and difficult for people with mobility impairments, such as older people, to receive. Objective: The objective of this study was to test if a novel, Web-based computerized version of a group training protocol called Memory Specificity Training, has the potential to increase autobiographical memory specificity and impact associated secondary psychological processes. Methods: A total of 21 participants (13 female; mean age 67.05, SD 6.55) who experienced a deficit in retrieving specific autobiographical memory were trained with c-MeST. We assessed memory specificity at preintervention and postintervention, as well as secondary processes such as depressive symptoms, rumination, and problem-solving skills. Results: Memory specificity increased significantly after participants completed c-MeST (r=.57). Session-to-session scores indicated that autobiographical memory specificity improved most from the online baseline assessment to the first Web-based session. Symptoms or secondary processes such as problem-solving skills did not change significantly. Conclusions: A Web-based automated individual version of MeST is a feasible, low-cost intervention for reduced memory specificity in healthy older adults. Future studies should clarify the preventive impact of c-MeST in other at-risk sample populations with longer follow-up times. ",
doi="10.2196/13333",
url="https://www.jmir.org/2019/5/e13333/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094362"
}


@Article{info:doi/10.2196/11599,
author="Ford II, H. James
and Dodds, Debby
and Hyland, Julie
and Potteiger, Michael",
title="Evaluating the Impact of Music \& Memory's Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study",
journal="JMIR Aging",
year="2019",
month="Mar",
day="14",
volume="2",
number="1",
pages="e11599",
keywords="Music \& Memory",
keywords="assisted living facilities",
keywords="quality of life",
keywords="agitation",
keywords="medication adherance",
keywords="iPod",
keywords="iPad",
keywords="implementation science",
keywords="patient participation",
abstract="Background: Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident's care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies. Objective: The aim of this study was to assess the impact of Music \& Memory's personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs. Methods: The data collected were on the utilization of iPods and iPads by the residents. Residents' outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents' QOL. A 1-way analysis of variance was utilized to examine changes in resident's agitation and QOL based on the resident's utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate. Results: A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents' engagement. PMATE utilization was not associated with changes in the residents' agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents' QOL was significant (P=.047), and the differences across ALCs were also significant (F25=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of ?5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers. Conclusions: The study is one of the first to explore the impact of Music \& Memory's PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents' QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings. ",
doi="10.2196/11599",
url="http://aging.jmir.org/2019/1/e11599/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518259"
}


@Article{info:doi/10.2196/games.8364,
author="Boendermaker, J. Wouter
and Gladwin, E. Thomas
and Peeters, Margot
and Prins, M. Pier J.
and Wiers, W. Reinout",
title="Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2018",
month="May",
day="23",
volume="6",
number="2",
pages="e10",
keywords="cognitive function",
keywords="memory",
keywords="video games",
keywords="motivation",
abstract="Background: Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants' motivation to train. Objective: This study aimed to evaluate whether adding game elements to the training could help improve adolescents' motivation to train while improving cognition. Methods: A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. Results: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. Conclusions: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time. ",
doi="10.2196/games.8364",
url="http://games.jmir.org/2018/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29792294"
}


@Article{info:doi/10.2196/formative.9083,
author="Zafeiridi, Paraskevi
and Paulson, Kevin
and Dunn, Rosie
and Wolverson, Emma
and White, Caroline
and Thorpe, Adrian Jonathan
and Antomarini, Marco
and Cesaroni, Francesca
and Scocchera, Francesca
and Landrin-Dutot, Isabelle
and Malherbe, La{\"e}titia
and Lingiah, Hendi
and B{\'e}rard, Marie
and Giron{\`e}s, Xavier
and Quintana, Maria
and Cort{\'e}s, Ulises
and Barru{\'e}, Cristian
and Cort{\'e}s, Atia
and Paliokas, Ioannis
and Votis, Konstantinos
and Tzovaras, Dimitrios",
title="A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability",
journal="JMIR Formativ Res",
year="2018",
month="Mar",
day="12",
volume="2",
number="1",
pages="e4",
keywords="dementia",
keywords="technology",
keywords="social support",
keywords="caregivers",
abstract="Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10\% (6/58). Results: After 1 week of platform use, the system was useful for 90\% (20.75/23) of the caregivers and for 89\% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82\%, 18.75/23; professionals: 97\%, 5.82/6) and their satisfaction with the platform (caregivers: 79\%, 18.08/23; professionals: 73\%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57\%, 13/23), ease of use (41\%, 9.4/23), and overall satisfaction (47\%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. ",
doi="10.2196/formative.9083",
url="http://formative.jmir.org/2018/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684403"
}


@Article{info:doi/10.2196/jmir.7981,
author="LaMonica, M. Haley
and English, Amelia
and Hickie, B. Ian
and Ip, Jerome
and Ireland, Catriona
and West, Stacey
and Shaw, Tim
and Mowszowski, Loren
and Glozier, Nick
and Duffy, Shantel
and Gibson, A. Alice
and Naismith, L. Sharon",
title="Examining Internet and eHealth Practices and Preferences: Survey Study of Australian Older Adults With Subjective Memory Complaints, Mild Cognitive Impairment, or Dementia",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="25",
volume="19",
number="10",
pages="e358",
keywords="eHealth",
keywords="dementia",
keywords="mild cognitive impairment",
keywords="Internet",
keywords="Alzheimer disease",
abstract="Background: Interest in electronic health (eHealth) technologies to screen for and treat a variety of medical and mental health problems is growing exponentially. However, no studies to date have investigated the feasibility of using such e-tools for older adults with mild cognitive impairment (MCI) or dementia. Objective: The objective of this study was to describe patterns of Internet use, as well as interest in and preferences for eHealth technologies among older adults with varying degrees of cognitive impairment. Methods: A total of 221 participants (mean age=67.6 years) attending the Healthy Brain Ageing Clinic at the University of Sydney, a specialist mood and memory clinic for adults ?50 years of age, underwent comprehensive clinical and neuropsychological assessment and completed a 20-item self-report survey investigating current technology use and interest in eHealth technologies. Descriptive statistics and Fisher exact tests were used to characterize the findings, including variability in the results based on demographic and diagnostic factors, with diagnoses including subjective cognitive impairment (SCI), MCI, and dementia. Results: The sample comprised 27.6\% (61/221) SCI, 62.0\% (137/221) MCI, and 10.4\% (23/221) dementia (mean Mini-Mental State Examination=28.2). The majority of participants reported using mobile phones (201/220, 91.4\%) and computers (167/194, 86.1\%) routinely, with most respondents having access to the Internet at home (204/220, 92.6\%). Variability was evident in the use of computers, mobile phones, and health-related websites in relation to sociodemographic factors, with younger, employed respondents with higher levels of education being more likely to utilize these technologies. Whereas most respondents used email (196/217, 90.3\%), the use of social media websites was relatively uncommon. The eHealth intervention of most interest to the broader sample was memory strategy training, with 82.7\% (172/208) of participants reporting they would utilize this form of intervention. Preferences for other eHealth interventions varied in relation to educational level, with university-educated participants expressing greater interest in interventions related to mood (P=.01), socialization (P=.02), memory (P=.01), and computer-based exercises (P=.046). eHealth preferences also varied in association, with diagnosis for interventions targeting sleep (P=.01), nutrition (P=.004), vascular risk factors (P=.03), and memory (P=.02). Conclusions: Technology use is pervasive among older adults with cognitive impairment, though variability was noted in relation to age, education, vocational status, and diagnosis. There is also significant interest in Web-based interventions targeting cognition and memory, as well as other risk factors for cognitive decline, highlighting the urgent need for the development, implementation, and study of eHealth technologies tailored specifically to older adults, including those with MCI and early dementia. Strategies to promote eHealth use among older adults who are retired or have lower levels of education will also need to be considered. ",
doi="10.2196/jmir.7981",
url="http://www.jmir.org/2017/10/e358/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29070481"
}


@Article{info:doi/10.2196/resprot.6864,
author="Boomsma, Funke Jooske Marije
and Exalto, Geertje Lieza
and Barkhof, Frederik
and van den Berg, Esther
and de Bresser, Jeroen
and Heinen, Rutger
and Koek, Lena Huiberdina
and Prins, Dani{\"e}l Niels
and Scheltens, Philip
and Weinstein, Chanoch Henry
and van der Flier, Maria Wiesje
and Biessels, Jan Geert",
title="Vascular Cognitive Impairment in a Memory Clinic Population: Rationale and Design of the ``Utrecht-Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment'' (TRACE-VCI) Study",
journal="JMIR Res Protoc",
year="2017",
month="Apr",
day="19",
volume="6",
number="4",
pages="e60",
keywords="vascular cognitive impairment",
keywords="memory clinic",
keywords="small vessel disease",
keywords="vascular disease",
keywords="prognosis",
keywords="dementia",
abstract="Background: Vascular Cognitive Impairment (VCI) refers to cognitive dysfunction due to vascular brain injury, as a single cause or in combination with other, often neurodegenerative, etiologies. VCI is a broad construct that captures a heterogeneous patient population both in terms of cognitive and noncognitive symptoms and in terms of etiology and prognosis. This provides a challenge when applying this construct in clinical practice. Objective: This paper presents the rationale and design of the TRACE-VCI study, which investigates the clinical features and prognosis of VCI in a memory clinic setting. Methods: The TRACE-VCI project is an observational, prospective cohort study of 861 consecutive memory clinic patients with possible VCI. Between 2009 and 2013, patients were recruited through the Amsterdam Dementia Cohort of the VU University Medical Centre (VUMC) (N=665) and the outpatient memory clinic and VCI cohort of the University Medical Centre Utrecht (UMCU) (N=196). We included all patients attending the clinics with magnetic resonance imaging (MRI) evidence of vascular brain injury. Patients with a primary etiology other than vascular brain injury or neurodegeneration were excluded. Patients underwent an extensive 1-day memory clinic evaluation including an interview, physical and neurological examination, assessment of biomarkers (including those for Alzheimer-type pathologies), extensive neuropsychological testing, and an MRI scan of the brain. For prognostic analyses, the composite primary outcome measure was defined as accelerated cognitive decline (change of clinical dementia rating ?1 or institutionalization) or (recurrent) major vascular events or death over the course of 2 years. Results: The mean age at baseline was 67.7 (SD 8.5) years and 46.3\% of patients (399/861) were female. At baseline, the median Clinical Dementia Rating was 0.5 (interquartile range [IQR] 0.5-1.0) and the median Mini-Mental State Examination score was 25 (IQR 22-28). The clinical diagnosis at baseline was dementia in 52.4\% of patients (451/861), mild cognitive impairment in 24.6\% (212/861), and no objective cognitive impairment in the remaining 23.0\% (198/861). Conclusions: The TRACE-VCI study represents a large cohort of well-characterized patients with VCI in a memory clinic setting. Data processing and collection for follow-up are currently being completed. The TRACE-VCI study will provide insight into the clinical features of memory clinic patients that meet VCI criteria and establish key prognostic factors for further cognitive decline and (recurrent) major vascular events. ",
doi="10.2196/resprot.6864",
url="http://www.researchprotocols.org/2017/4/e60/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28428166"
}


@Article{info:doi/10.2196/resprot.6570,
author="Ballesteros, Soledad
and Mayas, Julia
and Ruiz-Marquez, Eloisa
and Prieto, Antonio
and Toril, Pilar
and Ponce de Leon, Laura
and de Ceballos, L. Maria
and Reales Avil{\'e}s, Manuel Jos{\'e}",
title="Effects of Video Game Training on Behavioral and Electrophysiological Measures of Attention and Memory: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2017",
month="Jan",
day="24",
volume="6",
number="1",
pages="e8",
keywords="attention",
keywords="C-reactive protein",
keywords="cognitive training",
keywords="healthy aging",
keywords="inflammation",
keywords="electrophysiology",
keywords="video games",
keywords="working memory",
abstract="Background: Neuroplasticity-based approaches seem to offer promising ways of maintaining cognitive health in older adults and postponing the onset of cognitive decline symptoms. Although previous research suggests that training can produce transfer effects, this study was designed to overcome some limitations of previous studies by incorporating an active control group and the assessment of training expectations. Objective: The main objectives of this study are (1) to evaluate the effects of a randomized computer-based intervention consisting of training older adults with nonaction video games on brain and cognitive functions that decline with age, including attention and spatial working memory, using behavioral measures and electrophysiological recordings (event-related potentials [ERPs]) just after training and after a 6-month no-contact period; (2) to explore whether motivation, engagement, or expectations might account for possible training-related improvements; and (3) to examine whether inflammatory mechanisms assessed with noninvasive measurement of C-reactive protein in saliva impair cognitive training-induced effects. A better understanding of these mechanisms could elucidate pathways that could be targeted in the future by either behavioral or neuropsychological interventions. Methods: A single-blinded randomized controlled trial with an experimental group and an active control group, pretest, posttest, and 6-month follow-up repeated measures design is used in this study. A total of 75 cognitively healthy older adults were randomly distributed into experimental and active control groups. Participants in the experimental group received 16 1-hour training sessions with cognitive nonaction video games selected from Lumosity, a commercial brain training package. The active control group received the same number of training sessions with The Sims and SimCity, a simulation strategy game. Results: We have recruited participants, have conducted the training protocol and pretest assessments, and are currently conducting posttest evaluations. The study will conclude in the first semester of 2017. Data analysis will take place during 2017. The primary outcome is transfer of benefit from training to attention and working memory functions and the neural mechanisms underlying possible cognitive improvements. Conclusions: We expect that mental stimulation with video games will improve attention and memory both at the behavioral level and in ERP components promoting brain and mental health and extending independence among elderly people by avoiding the negative personal and economic consequences of long-term care. Trial Registration: Clinicaltrials.gov NCT02796508; https://clinicaltrials.gov/ct2/show/NCT02796508 (archived by WebCite at http://www.webcitation.org/6nFeKeFNB) ",
doi="10.2196/resprot.6570",
url="http://www.researchprotocols.org/2017/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28119279"
}


@Article{info:doi/10.2196/rehab.4155,
author="Gamito, Pedro
and Morais, Diogo
and Oliveira, Jorge
and Ferreira Lopes, Paulo
and Picareli, Felipe Lu{\'i}s
and Matias, Marcelo
and Correia, Sara
and Brito, Rodrigo",
title="Systemic Lisbon Battery: Normative Data for Memory and Attention Assessments",
journal="JMIR Rehabil Assist Technol",
year="2016",
month="May",
day="04",
volume="3",
number="1",
pages="e5",
keywords="Systemic Lisbon Battery",
keywords="attention",
keywords="memory",
keywords="cognitive assessment",
keywords="virtual reality",
abstract="Background: Memory and attention are two cognitive domains pivotal for the performance of instrumental activities of daily living (IADLs). The assessment of these functions is still widely carried out with pencil-and-paper tests, which lack ecological validity. The evaluation of cognitive and memory functions while the patients are performing IADLs should contribute to the ecological validity of the evaluation process. Objective: The objective of this study is to establish normative data from virtual reality (VR) IADLs designed to activate memory and attention functions. Methods: A total of 243 non-clinical participants carried out a paper-and-pencil Mini-Mental State Examination (MMSE) and performed 3 VR activities: art gallery visual matching task, supermarket shopping task, and memory fruit matching game. The data (execution time and errors, and money spent in the case of the supermarket activity) was automatically generated from the app. Results: Outcomes were computed using non-parametric statistics, due to non-normality of distributions. Age, academic qualifications, and computer experience all had significant effects on most measures. Normative values for different levels of these measures were defined. Conclusions: Age, academic qualifications, and computer experience should be taken into account while using our VR-based platform for cognitive assessment purposes. ",
doi="10.2196/rehab.4155",
url="http://rehab.jmir.org/2016/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582246"
}


@Article{info:doi/10.2196/jmir.3377,
author="Tedim Cruz, V{\'i}tor
and Pais, Joana
and Alves, Iv{\^a}nia
and Ruano, Lu{\'i}s
and Mateus, C{\'a}tia
and Barreto, Rui
and Bento, Virg{\'i}lio
and Colunas, M{\'a}rcio
and Rocha, Nelson
and Coutinho, Paula",
title="Web-Based Cognitive Training: Patient Adherence and Intensity of Treatment in an Outpatient Memory Clinic",
journal="J Med Internet Res",
year="2014",
month="May",
day="07",
volume="16",
number="5",
pages="e122",
keywords="cognitive training",
keywords="neurorehabilitation",
keywords="Web-based training",
keywords="eHealth systems",
keywords="training intensity",
keywords="adherence",
keywords="memory clinic",
abstract="Background: Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems. Objective: The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training). Methods: A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, ``COGWEB'', on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions. Results: The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8\% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027). Conclusions: Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity. ",
doi="10.2196/jmir.3377",
url="http://www.jmir.org/2014/5/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24808451"
}