Dementia is the leading cause of cognitive impairment, resulting in memory loss, aphasia (language disorder), agnosia (loss of ability to recognize objects, persons, sounds, shapes, or smells), apraxia (disorder of motor planning), visuospatial, or executive dysfunction (Bharucha et al. 2009). Worldwide, 28 million people suffer from dementia, which annually accounts for $156 billion in direct-care costs (Wimo et al. 2006). In 2005, the UK reported an estimated 684,000 people with dementia. This figure is forecasted to increase in the UK to 940,000 by 2021, and 1,735,000 by 2051 (Knapp et al. 2007). On a global scale, figures are expected to reach 81.1 million by 2040 (Neubauer et al. 2008).

To date, there is no cure for dementia, however, there do exist some pharmaceutical methods to ameliorate the symptoms of cognitive dysfunction (Oremus and Tarride 2008). The disease not only affects the patient, but also has an effect on informal/formal carers in the form of physical strain, emotional stress, and financial hardship (Rosa et al. 2010). Most people with dementia would prefer to stay at home, and it has been shown that their quality of life is better than for those who are institutionalized (Rivlin and Wiener 1988). Nevertheless, institutionalization is often necessary as a result of the deterioration in the condition, combined with overpowering carer burden (Rosa et al. 2010).

More recently, information and communication technology (ICT) solutions have been developed as a means to complement, or to serve as an alternative to, pharmaceutical treatments (Bharucha et al. 2009; Nugent 2007). Both people with dementia and their carers are looking to technology to empower people with dementia, allowing for greater independence. From a carer’s perspective, decreasing the number of interactions required to assist people with dementia to complete ADLs also has a direct positive impact on carer burden (Mihailidis et al. 2008).

In the past, people with dementia and their carers have attempted to provide memory/reminding support through the use of calendars or diaries to highlight daily schedules or upcoming appointments. Such approaches, however, require the user to actively engage with the supporting mechanism, and they therefore are prone to being overlooked due to the inherent symptoms of dementia. Typically, items are placed in full sight of users (e.g. Post-it notes on the fridge or door) or in routine places (e.g. diary beside the telephone or kitchen table; calendar on the wall). It is postulated that everyday technologies, such as mobile phones, can overcome the limitations of the aforementioned reminding supports by providing proactive reminding support. That is, to actively alert users about upcoming appointments or reminding them about important ADLs. The research reported herein aims to evaluate a mobile-phone based video reminder system for people with dementia, with respect to its design and utility, in addition to its ability to satisfy user needs.

A pilot study with nine subjects was performed to assess the complexity and difficulty of undertaking systematic research in the area of technology development for a cohort with digressing cognitive abilities. It was appreciated that no generalized findings could be derived from such a small sample; however, the study provides the opportunity to gain an indication and a better insight of the utility of the technology and highlights where improvements to the technology or the trial protocol are necessary. The results are presented and discussed, and the future plans of the work are outlined.

State-of-the-Art of Technology to Support Prospective Memory

A person with physical impairment can be helped by developing technology that removes the environmental barriers that turn a person’s impairment into a disability. People with cognitive impairments, however, can benefit from technology aiding them to understand their environment, formulate plans, carry out actions, communicate, or remember what they have done or where they are (Sixsmith et al. 2007).

An important aspect of successfully implementing ICT solutions is to fully appreciate the user needs within the consideration of the circumstances of people with dementia. In order to investigate these needs, the Investigating Enabling Domestic Environments for People with Dementia (INDEPENDENT) project created a wish list, trying to identify where technology can help to bridge the gap (Sixsmith et al. 2007). In their view, the aim of technology development should be: to detect and compensate for functional decline, help to delay the onset of disablement, provide support to carers, and postpone the movement to residential care (Sixsmith et al. 2007). The authors identified several key areas through focus groups and interviews: 1) personal aspects such as memory (key issue), ability to communicate, behavioral issues, and initiative; 2) the support and social networks, such as the effect on carers and family members, general relationships; 3) the physical environment symbolized through initiation, motivation, stimulation; 4) the influence of the outside world and lived environments; and 5) the consideration of safety and security. Last but in no way least, the socio-cultural environment with its provision of information, cultural, and spiritual activities has been largely ignored in the development of technology for people with dementia (Sixsmith et al. 2007). The well-being and quality of life of people with dementia will be enhanced if the intervention facilitates activities that are meaningful and valued by the person and takes into account the contextual factors within a person’s life.

In terms of technology development, according to Sixsmith et al., it is important to keep solutions very simple with intuitive controls. Even screw heads can be perceived as buttons, so the control has to stand out clearly from the background. Upon usage of the controls, an immediate effect has to happen, be it in terms of a confirming noise or an immediate action (e.g. video starting, illumination), even short delays can cause confusion and lead to the feeling of incapability and failure to use the system. Opening and shutting of lids seems to be a very intuitive way to control technology, as does touching a picture on a touch screen or button (Sixsmith et al. 2007).

Sixsmith et al. see the biggest challenge in developing intuitively controlled technology as being the testing of its ease of use. The feeling of being tested can cause anxiety in people with dementia, leading to over-thinking the task at hand rather than using their intuition. The Wizard-of-Oz technique might be a way around that, giving the participants the feeling that they are not watched, yet monitoring their approach and success (Sixsmith et al. 2007). The Wizard-of-Oz technique is used in order to test a computerized system where the user believes the system is acting autonomously, however, it is unnoticeably operated by a researcher; this approach is gaining increased interest in the development of cognitive prosthetics (Liu et al. 2008; Sixsmith et al. 2007).

Technology that requires learning of multiple-step procedures is prone to failure, as they fall exactly in the range of impairments to be experienced by people with dementia: failing to start, stalling, forgetting a required component, or performing the activity incorrectly (Modayil et al. 2008).

Based on the analysis of user needs, research is required to provide prompting and monitoring technology to help with dressing, taking medication, and preparing food and drink (Wherton and Monk 2008). Furthermore, technology should ensure safety in the kitchen and help with washing oneself and toileting. There is also a need for systems that facilitate leisure activities and interpersonal communication (Wherton and Monk 2008).

Research-Based Systems

A prosthetic, from the Greek “prostithenai” meaning “to add to, or to put in addition”, is a device or piece of equipment aiming to replace or support a bodily function or limb. For people with cognitive impairment, it aims to support the ability to perform the cognitive processes needed to plan and execute actions and procedures (Wherton and Monk 2008).

Non-technological aids typically involve diaries, calendars, and wall charts. With the introduction of mobile technology, pagers have been used to schedule reminders (Hersh and Treadgold 1994); however, the reliance on service providers, the one-directional communication, and the relatively high costs associated with their usage have limited their uptake to date (Schulze 2004).

Memojog is a PDA with mobile telephony, which delivers text-based reminding prompts (Szymkowiak et al. 2004). The user has to acknowledge the receipt of the reminder. If the acknowledgement is not received, the system will contact the carer by SMS, voice call, or email. Memojog also provides the option to store birthdays, addresses, and appointments. Morrison et al. trial tested the system on 12 elderly and memory-impaired users who had to perform a set task (e.g. find out a certain birthday) and subsequently rate the difficulty of the task. This exercise was repeated after 2–3 weeks. Whereas most of the users found the system easy to use, four of the 12 participants did drop out, and it is not clear what level of independence the remaining participants had. The authors concluded that the participants valued the additional functionality of diary, phone book, and appointments but that technological issues limited the utility of the system. There were problems with network coverage, and the software was lost and had to be reinstalled every time if the PDA’s battery ran out. The touch screen was not sensitive enough and particularly posed a problem for people with a tremor. No further improvement of the technology has been found in the literature since 2004 (Morrison et al. 2004).

A touch screen was also used by Davies et al. to investigate, from a service perspective, how to achieve patient empowerment, greater autonomy, and enhanced quality of life for older people with mild dementia (Davies et al. 2009). The COGKNOW system facilitates remembering and social contact, supports activities of pleasure, and enhances the feeling of safety. After performing workshops and interviews to elicit the user needs, one service or solution was implemented for each of these areas: a reminding service, picture dialing, a music player, and a warning if the door was left open; all were implemented through the same touch-screen computer in addition to a mobile device mirroring the same functions. Sixteen people with dementia and their carers assessed user-friendliness and usefulness of the services. The stationary device was more successful than the mobile device as participants had difficulties reading the information displayed on the smaller screen. The feedback about the services involved the wishes for more personalization in the cases of the reminders and the music/radio function, but they were seen as useful and enjoyable. The picture-dialing function was too complex with a three-level menu, but the door sensor was well received and should be extended to other doors or devices. Further iterations of development and assessment are envisaged.

Orpwood et al. designed a sequence support, guiding the user via a screen-based system to perform sample tasks such as putting a cassette into a player, finding a program on TV, and placing a letter in an envelope. They compared the guidance in form of text display, the use of photos, videos, and audio recordings. The researcher, who could not be seen by the user, decided when the next prompt was due. Both the video and photo-based guidance led to difficulties as the cohort of people with dementia aimed to follow exactly what was shown on the screen, and a different angle of perspective caused great confusion. The text version was more successful, in particular when coupled with the audio recording. Feedback suggested that participants would have liked to be able to refer to a previous step. Further work is required to implement the recognition of completion of a subtask (Orpwood et al. 2009).

A system combining the functionality of the above technologies is the Planning and Execution Assistant and Trainer (PEAT), a mobile phone-based solution that guides users through an activity by providing subtask guidance (Modayil et al. 2008). Recently, PEAT has been upgraded to work together with a range of sensors such as an RFID-equipped bracelet worn around the wrist to interface with RFID-tagged items, or the inclusion of pressure mats and GPS. If the users stall, use the wrong item, or go to the wrong location, they can be prompted to correct the outcome. The system can also be used for therapeutic monitoring. PEAT has been criticized in the literature for automatically providing a reminder for each planned activity irrespective of whether the activity has already been performed before (Pollack et al. 2003). The incorporation of the sensors into the system overcomes this limitation, providing principled reasoning about what reminder to issue and when. PEAT is commercially available; however, no literature could be found on the evaluation of the system’s impact on the target population of people with memory impairment.

The Autominder system is another system where much work has been reported with respect to plan-based reasoning (McCarthy and Pollack 2002). The investigators believe that a cognitive orthotic should reason about what reminders should be issued and when, whilst ensuring that users are aware of planned activities so as to avoid introducing inefficiency into the user’s activity and annoying the user. The system works by constantly re-writing the plan, therefore achieving the plan with the highest quality possible. In the current configuration, a robot follows a user, providing feedback of the position and actions performed. No further sensors have been incorporated to date (Pollack et al. 2003; Lauriks et al. 2007), and whereas the system has been tested on older volunteers, these were again not people with dementia but people interested in new technology (Pollack et al. 2003). This is a very interesting piece of research, however, the associated cost limits its potential for commercialization.

Other systems have been developed, providing context-aware memory embedded within spectacles (DeVaul 2010), or guiding the user through ADLs such as cooking (Cook’s Collage; Tran et al. 2007) or hand washing (COACH; Mihailidis et al. 2008). The latter, however, only tackle one specific task in a much broader domain of dysfunction. On the other hand, they do lead the way in the development of cognitive orthotics, functioning without any explicit input from the user or carer (Mihailidis et al. 2008).

Commercially Available Systems

Several prompting and cueing systems are commercially available, most of which provide a similar utility. Voice Cue (QED), MEM-X (QED), and Timepad (Attainment Company) are devices delivering pre-recorded messages at a scheduled time on a device similar to a pager.

Pocket Compass (AbleLink Technologies), Community Integration Suite (AbleLink Technologies), and Schedule Assistant (AbleLink Technologies) are systems on PDAs designed to deliver reminders scheduled for a pre-defined time. In addition to that, the Jogger (Independent Concepts), ISAAC (Cogent Systems), Pocket Coach (AbleLink Technologies) and Visual Assistant (AbleLink Technologies) also have the utility to guide the user through the different steps of an activity.

Prompts and cues are delivered by text and natural or synthesized speech. The Pocket Coach system also provides a personalized feedback message for positive reinforcement once the tasks have been completed. The Jogger is a server-operated system, whereby the carer can upload the reminders via the Web.

No details of clinical trials or evaluations could be found in the literature or the Web about those systems. The challenge lies in the design of such an evaluation, as standard randomized controlled trials might not lead to relevant results. It is impossible to use blinding techniques when administering reminders, and each participant has different cognitive challenges, hence the technology has to be personalized. Routine plays a vital role in the success of managing everyday life for people with cognitive impairments, and establishing a new routine with the technology is vital before any conclusions can be drawn about its effect or success rate.

MPVS System Overview

The systems presented above provide good utility with respect to delivering reminders and prompts to guide people with dementia through their ADLs. It is particularly important, however, to customize the reminders to the person and to give a sense of familiarity. Zingmate et al. found that familiarity is vital and means sharing everyday life in a sense of nearness, and encountering a sense of belonging (Zingmark et al. 2002). The MPVS system thus delivers its reminders in the form of a video of the respective informal carer, hence communicating not only the reminder, but also the associated emotions. In this way, the person with dementia not only gets a reminder, but also has the feeling of being in contact with his or her daughter / son / partner, who acts as virtual caregiver.

The cognitive prosthetic used in the presented evaluation was in the form of a mobile phone (Sony Ericson W880i) that was modified so that only a single large button is available to users. In addition, a client-server-based carer interface is available to the carers so that they may record and schedule new video-based reminders. This prototype has previously been described (Donnelly et al. 2008), with a limited evaluation being presented (Donnelly et al. 2010). Figure 1 presents a general overview of the main technical components of the system. Carers can record a video reminder via a Webcam and microphone (see letter A, Fig. 1) and schedule the time and date when it should be delivered to the person with dementia. The carer also has the option to set the recorded reminder to automatically repeat, for example, daily or weekly. Recorded reminders are subsequently uploaded to a dedicated server (B). Once all of the reminders are recorded, the carer has the opportunity to print a list with times and the categories the reminders belong to, i.e. meals, entertainment, appointments etc., to monitor the correct delivery of the reminders in addition to the accomplishment and performance of the person with dementia. Potentially, this list could also be used for temporal orientation of the person with dementia, as they can check when a certain task is due to be performed. At regular intervals, the cognitive prosthetic contacts the dedicated server and requests for any new schedule and video data to be downloaded to the handset (C). When a reminder is due, the user is prompted to press the button on the handset to initiate the reminder playback. This interaction also serves as the acknowledgement of the reminder, which is sent back to the server so that carers can monitor reminder delivery. During those times when a reminder is not being delivered via the device, a large clock, including date and time information, is presented to the user.

Fig. 1
figure 1

Technological solution highlighting the links between the various technical components (adopted from Donnelly et al. 2008)

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As previously highlighted, the keypad of the mobile phone was altered by applying a silicon-based cover to “hide” the standard keypad and to provide users with a “single-button” device. Each video reminder announces itself by forcing the display background to illuminate X seconds before the alarm sounds. Once the user acknowledges the alarm, the video is played with the message of the carer. If the alarm is missed, it will reappear again “X” minutes later. All “X” values can be personalized on a user-by-user basis.

Methodology of Trial

This research aims to evaluate a mobile phone-based video-reminder system for people with dementia with respect to its design and utility, in addition to its ability to satisfy user needs.

The technology has undergone several iterations of user evaluations and subsequent technology improvements. Prior to this research, 30 people, including older people and people with dementia, have tested and assessed the system (Donnelly et al. 2008; Donnelly et al. 2010). Following the latest technological improvements, including the addition of repeat reminders as well as a wizard-led carer interface, the system was trial-tested in a more formal setup.

The evaluation was designed as an ABA evaluation, following the example from Wilson et al. who conducted an ABA evaluation, with a 2- to 6-week A phase to establish baseline memory failures, a 12-week B phase where reminders were issued by a pager, and another 3-week A phase where the subjects were again relying on their previous technique (Wilson et al. 1997). The baseline success rate of 37.05% increased to 85.46% with support from the pager and dropped to 74.46% in the second A phase. This suggests that some people with dementia benefited long-term from the technology, which helped them to establish a routine that they managed to maintain afterwards. Other participants, however, were completely reliant on the technology to perform the desired tasks, such as performing their morning routine and preparing their lunch.

This ABA trial design has been adapted for the current study. It started with the A phase, where the person with dementia and their carer used their normal method of reminding to perform a set of tasks (control phase). It was followed by the B phase, where the cognitive prosthetic was introduced to remind them of the same set of tasks. To complete the evaluation, the A phase was repeated, using the same method of reminding as in the first iteration.

Methods

Potential participants were identified by clinical research staff during routine attendance at the outpatient Memory Clinic at the Belfast City Hospital and given an information leaflet and phone number to call if they were interested in participating. Patients with mild dementia were invited to participate, provided they were living alone, or with a willing carer able to participate in identifying user needs and engage with researchers to record reminders using a remote computer/Webcam. As both persons with dementia and next of kin were recruited to participate in the project, both persons were involved in the informed-consent procedure. This meant that before they were invited to participate in the project, they were informed about the project aims and methods by written and oral information. Those who agreed to participate were asked to sign the informed-consent form.

It was aimed to enroll 10 participants, five with mild cognitive impairments (MCI) and five with Alzheimer’s disease (AD), both with a Mini Mental State Examination (MMSE) result of greater than 18. On enrolment to the study, the baseline characteristics of the people with dementia were assessed using the following scales: Cognition was determined with MMSE; the functional ability for participants with AD was tested with the Disability Assessment for Dementia (DAD); and the abilities of participants with MCI with respect to their instrumental activities of daily living (iADL) were determined with the iADL scale (Lawton and Brody 1969).

The participants were set eight tasks that they had to perform following either their routine choice of reminding technique in the A phase, or the video reminders from the mobile phone in the B phase. These tasks were: Acknowledge trial start, drink a glass of water or juice, eat a sandwich, watch the favorite news program or a different-type of TV program, charge the phone, take the medication or ask for it, acknowledge trial end, and a reminder of choice. The reminder was recorded by the carer and set to be delivered at an agreed time. The carer then noted if the task was fulfilled and if assistance was required to do so. In addition, the phone recorded the acknowledgement of the reminder by the participant in addition to a “heart-beat” to record viable reception. Before and after the evaluation, a research nurse administered a questionnaire via a face-to-face interview. This questionnaire queried topics such as user needs, current methods of reminding, user satisfaction, and user friendliness of the technology, in addition to the impact of such technology on everyday life. Each phase lasted for two days, thus limiting the potential of upset to people with dementia in case of instability of the technology or anxiety with its use; yet each phase was still of sufficient duration to provide a platform to test this evaluation design and the technology itself.

Results and Discussion

Nine participants and their carers were recruited, seven with MCI and two with AD. The average age of the participants was 71.7. The median MMSE score was 29, with an interquartile range (IQR) of 1 and a total range of 23–30. For further characteristics of the enrolled participants refer to Table 1. Prior to the study, all participants were deemed to be familiar with mobile phones and also owned one, however, three participants could not find it. The mobile phones were used to call out (3), to call and receive (2), and also for writing SMS (3). Only one participant used the in-built reminder function to help him organize his day. In a similar way, carers stated that they owned and used a mobile phone, however, not to help them organize their schedule. Seven of the participants and most of the carers had access to a computer at home, and it was used for typing letters and emails, surfing the Internet, and buying groceries and other items.

Table 1 Characteristics of the enrolled participants
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Two participants had issues remembering that they were a part of a user trial. Their responses are included in the data but have to be considered carefully. If the total presented data does not add up to nine, these participants could not remember the subject of the respective question.

User Needs Assessment

Prior to the ABA-evaluation, the perceived user needs were established, aiming to find out which areas of need could be indentified for which reminding support could offer assistance. The results are summarized in Table 2. All people who were surveyed were in the early stages of dementia. Interestingly, none of the participants admitted to needing reminders to eat or drink, which had been perceived as very relevant by the researchers prior to the study. The reason for this, however, might also be that the meals are often prepared by the carer and then eaten together. Also, eating is a fundamental desire, which people with MCI are likely to still possess. In this case, it would not be perceived as a specific reminder different to a call to eat in any family. Three participants used Post-it notes or diary entries to remind them of upcoming entertainments, such as a favorite TV show. All participants needed support to adhere to appointments, of which they were reminded by the carer either personally or by phone call. They used Post-it notes or diary entries, and one participant even used the mobile phone to remind himself of upcoming appointments.

Table 2 User needs as perceived by people with MCI and early stage AD
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Only three participants needed support to remember taking medication, which was performed either by the carer, or by means of a medication box. Others were simply reminded by the medication box left sitting out. Remembering generic housework such as doing the dishes or vacuuming was not perceived as an issue, yet again it is not clear if that was due to the carer performing these tasks anyway. All but one of the participants needed reminding to make phone calls, where most of them were managed through Post-it reminders or entries in a diary or calendar.

Technology Evaluation

Following the ABA-evaluation, the participants and their carers were asked about usability and utility of the technology. Participants either reported liking the technology or could not remember having evaluated it. Generally, the solution was perceived as simple and easy to use and as a useful addition to current methods. It helped the participants to plan their day, in particular as they could look up the scheduled activities on the print out and refer to the mobile phone to identify the current date and time. Unfortunately, due to technical issues with the prototype, some of the repeat-reminders were not delivered, and two participants managed to abort the program on the phone accidentally. This could be helped through a phone call, guiding them to restart the application as it automatically starts up once restarting the phone. The technology caused anxiety in two participants who were waiting for the reminders to come through and who had to run for the phone if the alarm sounded. One participant stated that it caused confusion, as she didn’t remember what to do with it and tried to leave messages on the phone. These issues are typical for people with dementia and were particularly pronounced as the B phase—and thus the time to get used to the new technology—was so short.

Six participants found it very easy and two found it easy to use the phone, and five participants stated that it helped reminding them of the tasks they were meant to do. Two participants, however, concluded that it didn’t help, one of which though did not admit to having memory issues. With respect to the hardware, the participants concluded that the button was of perfect size and that overall, the mobile phone was just of the correct size not to get lost in the handbag but also not too bulky to carry on a lanyard around the neck. Image clarity of the videos was stated to be very good (6) or good (2), and the screen size seen as neither too large nor too small. The alarm sounded with a cuckoo sound, which some of the participants would have wished to be louder (3), whereas others thought it was just right (3). One participant thought it was quite loud. The audio quality of the video message was reported to be very clear (2) and clear (6). Ideally, the phone should be worn on a lanyard around the neck to always be present, however, only three participants did wear it this way. It has been reported in the literature (Robinson et al. 2008) that people with dementia are worried about being stigmatized when displaying assistive technologies, so one of the questions was the level of embarrassment if the reminders sounded in public. One participant left the phone at home when he left the house, and for four others there was no reminder in public.

One participant concluded that he was neither confident nor embarrassed, and two participants stated that they were confident when their reminders sounded. Presumably, the participant who left the phone at home deliberately was embarrassed, but otherwise the response did not show a great level of embarrassment.

The carers were also questioned about the usability of the reminder recording and scheduling software, and there was a slightly more mixed response. One found it very easy and others found it easy to use (3), however, two weren’t too sure and one found it difficult to record the reminders. This caused the feeling of discomfort in two carers, which might have been less pronounced if the recordings had been taken without the presence of the research nurse, as stated by three carers. The level of comfort of one carer, however, was increased by the assurance of the research nurse. Three carers were indifferent in this matter.

Even though this was a very short evaluation, the attempt was made to investigate what potential effect the technology could have on the level of burden on the carer; however, only one carer said that they felt that some of the responsibility had been lifted, and four others disagreed with this perception. Again, one carer thought it might lessen their worries, whereas two disagreed. All the others could not judge the potential impact. In terms of saving time of the carer because the participants completed a task by themselves and didn’t need reminding of it, one agreed that there was an impact, whereas again, four disagreed with this observation. On the other hand, three carers could see the potential of the technology to look after their care-recipient at home for a little longer, which was countered by two carers. None of the carers could quantify the additional amount of time that they saw themselves as capable of looking after their mother/father/partner, due to the use of technology. Five carers also thought it would be a good idea to be able to reschedule reminders through their own mobile phone, whereas one didn’t think he would use this option and one didn’t want their own phone involved in this. All of the carers thought it would be fantastic if sensors could identify the level of accomplishment of a task, and if that information was fed back to the carer.

Task Compliance

The average completion of the eight tasks was calculated for each phase, as well as the standard deviation, and was as follows: A: 6.9 ± 2.7; B: 5.4 ± 2.9; A: 6.6 ± 2.7.

As previously mentioned, there were some technical issues with repeat-reminders for one participant, and with the termination of the application for two other participants. If these participants are taken out of the analysis, the completion rate was as follows: A: 6.3 ± 3.2; B: 6 ± 3.3; A: 6.2 ± 3.3. These numbers are still quite low, which is due to one participant who did not complete any of the tasks—neither in the A nor in the B phases. This was not due to any technical fault.

When ignoring the participants where technical issues occurred, there was no difference in the completion rate. Due to the low number of samples though, no statistical analysis was performed to identify a statistically significant difference between the phases. Whereas for a long-term perspective one would hope that the technology would not only be as good as the currently used methods, but even better, it has to be kept in mind that learning new approaches, and particularly using new technology, is very difficult for people with cognitive impairments. Being able to perform the tasks equally well with the mobile phone as they would have done with standard support mechanisms is thus a positive outcome.

The presented trial also aimed to probe the users’ willingness to pay (WTP) for this technology; however, the results were inconclusive. It is currently not clear if this was due to the wording of the questions, the range of monetary values given, or the lack of experience the participants had in purchasing, using, and valuing such ICT solutions.

Conclusion

A mobile phone-based reminding system has been assessed, helping people with AD and MCI to manage their ADLs. Nine participants found it helped them organize their routine, and the phone used to deliver the video messages was of a good size with adequate screen and audio clarity. The carers saw the potential utility of the technology; however, they were unable to quantify such a benefit following such a short period of time using it. Although some had issues during initial use, the wizard-led interface made it a lot easier to use for people with minimal computer experience.

Generally, the evaluation was limited due to the short duration and the low sample number. This approach, however, facilitated the testing of the technology at an early stage in its development and provided essential user feedback regarding necessary refinements prior to future evaluations.

The technical issues that led to the difficulties experienced by three participants (repeat-reminders didn’t sound, and participants managed to abort the application) have to be addressed. Lab-based test are ongoing, including the development and testing of an improved software version before attempting a longitudinal trial.

In the proposed extended-longitudinal trial, the participants will make use of the phone during several weeks or months, giving them a chance to fully incorporate the technology into their everyday life. The hope is that this will then lead to a better appreciation of the utility, and thus also make it possible to quantify the effect of the technology on the user and their carer.