Clinical Manifestations.

Abstract

The number of smartwatch users worldwide continuously increased within the last 5 years. Still, older adults and patients with dementia miss to profit from opportunities of wearable assistive technologies. Factors that influence technology adoption were reviewed extensively in theory, based on theoretical models and scales, but empirical evidence is scarce. We hypothesized that interventions from smartwatches can trigger certain behaviors in PwD or persons with MCI to address specific domains which are affected in neurodegenerative diseases. Based on semi-structured interviews with caregivers, medical experts and persons with dementia (n = 10, respectively) we identified four domains with need for assistance. After prototype testing, we implemented two tasks presented by the smartwatch, covering the domains "nursing" and "activity". The watch prompted the user to A) drink some water and B) circle bells on a worksheet. Participants were randomly assigned to group 1 (regular, n = 20) or group 2 (intensive, n = 20). The modes varied in intervention-intensity with two different levels of vibration intensity, loudness and additional animations. If patients did not react as intended, interventions were repeated up to three times, irrespective of the group. Observations took place in a university hospital. Patients' reactions were remotely observed via cameras. Participants' feedback was obtained with questionnaires after the observation. Participants of group 1 and 2 did not differ with respect to mean age, cognition (MMST) or sex. Interventions in intensive mode were more often successful (n = 30/40) than regular interventions (n = 18/40). "Non-responder" (patients that completed no task) were only found in group 1 (n = 6). Task A was completed more often (n = 32/40) than task B (n = 16/40). Surprisingly, repetitions improved the outcome only in 4 cases, but failed in 32 cases. The vast majority of participants reported sufficient visibility and audibility of smartwatch content (n = 35/40). Obtaining users' feedback was challenging via usability questionnaires, which contained negatively and positively worded items on a 5-step Likert scale. Smartwatches can be customized to interact positively with older adults with cognitive impairment and influence behavior of PwD or MCI at least on short-term. Further empirical studies are necessary to enhance design and functional range of devices.