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Enabling remote assessment of cognitive behaviour through mobile experience sampling

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Enabling remote assessment of cognitive behaviour through mobile experience sampling

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Cognitive decline is among the normal processes of ageing, involving problems with memory, language, thinking and judgment, happening at different times and affecting people’s lives to a significant extent. Traditional clinical methods for cognitive assessment are conducted by experts once first symptoms appear. Mobile technologies can help supporting more immediate, continuous and ubiquitous measurements, thus potentially allowing for much earlier diagnosis of cognitive disorders. We present in this paper a digital mobile tool to administer cognitive tests in the form of multimedia experience sampling methods (ESM), which can run on a smartphone and can be scheduled and assessed remotely. The tool integrates digital cognitive ESM with passive sensor data that can be used to study the interplay of cognition and physical, social and emotional behaviours. We implement the Mini-Mental State Examination (MMSE) test, a clinical questionnaire extensively used to assess cognitive disorders, in order to showcase the possibilities offered by the proposed tool. Initial usability results show the tool to be perceived simple, easy and accessible for cognitively unimpaired persons.

Cognitive decline is among the normal processes of ageing, involving problems with memory, language, thinking and judgment, happening at different times and affecting people’s lives to a significant extent. Traditional clinical methods for cognitive assessment are conducted by experts once first symptoms appear. Mobile technologies can help supporting more immediate, continuous and ubiquitous measurements, thus potentially allowing for much earlier diagnosis of cognitive disorders. We present in this paper a digital mobile tool to administer cognitive tests in the form of multimedia experience sampling methods (ESM), which can run on a smartphone and can be scheduled and assessed remotely. The tool integrates digital cognitive ESM with passive sensor data that can be used to study the interplay of cognition and physical, social and emotional behaviours. We implement the Mini-Mental State Examination (MMSE) test, a clinical questionnaire extensively used to assess cognitive disorders, in order to showcase the possibilities offered by the proposed tool. Initial usability results show the tool to be perceived simple, easy and accessible for cognitively unimpaired persons.

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Enabling remote assessment of cognitive behaviour through mobile experience sampling

  1. 1. Jan Wohlfahrt-Laymann, Hermie Hermens, Claudia Villalonga, Miriam Vollenbroek-Hutten, Oresti Banos EmotionAware (PerCom2018) March 23, 2018 o.banoslegran@utwente.nl @orestibanos http://orestibanos.com/ 23-Mar-18 1 Enabling remote assessment of cognitive behaviour through mobile experience sampling
  2. 2. @orestibanos http://orestibanos.com/ Context  Circa 15% of adults over 60 suffer from a cognitive disorder [who16] and 47.5 million people are affected by dementia, with 7.7 million new cases every year [who17] 2 [who16] World Health Organization (2016) Mental health and older adults. http://www.who.int/mediacentre/factsheets/fs381/en/ [who17] World Health Organization (2017) Dementia. http://www.who.int/ mediacentre/factsheets/fs362/en/
  3. 3. @orestibanos http://orestibanos.com/ Measuring cognition  “The guiding idea of cognitive science is that mental operations involve processing information, and hence that we can study how the mind works by studying how information is processed” [ber14] 3 [ber14] Bermudez JL (2014) Cognitive Science: An Introduction to the Science of the Mind. Cambridge University Press. Perception, Attention, Memory, Language skills Visuospatial processing, Executive functions
  4. 4. @orestibanos http://orestibanos.com/ Measuring cognition: (traditional) clinical tests 4 Addenbrooke's Cognitive Examination Montreal Cognitive Assessment Saint Louis University Mental Status Exam Mini Mental State Examination
  5. 5. @orestibanos http://orestibanos.com/ Measuring cognition: challenges and opportunities 5 � Tests administered quite occasionally (normally during intake meetings and/or after first symptoms are detected) � Person needed to introduce the test and collect the answers � Presence of expert may bias the responses of the patient Addenbrooke's Cognitive Examination Montreal Cognitive Assessment Saint Louis University Mental Status Exam Mini Mental State Examination Cognitive functioning is shown in our daily behavior?!
  6. 6. @orestibanos http://orestibanos.com/ MobileCogniTracker: mobile ESM + passive sensing 6 (Cognitive) Experience Sampling Methods (Cognitive) Passive Sensing
  7. 7. @orestibanos http://orestibanos.com/ MobileCogniTracker: system overview 7 Platform Sensing Infrastructure Accelerometer Applications Barometer Bluetooth Communication ESM Light Gyroscope Magnetometer Locations Telephony Scheduler Temperature Screen Text-2-Speech Proximity Network Apps + PLUGINS/ PROBES! Battery AWARE http://www.awareframework.com/ (Cognitive) Experience Sampling Methods (Cognitive) Passive Sensing +
  8. 8. @orestibanos http://orestibanos.com/ MobileCogniTracker: system overview 8
  9. 9. @orestibanos http://orestibanos.com/ Cognitive ESMs (Examples) 9 Orientation Language
  10. 10. @orestibanos http://orestibanos.com/ Cognitive ESMs (Examples) 10 Language Repetition Complex tasks
  11. 11. @orestibanos http://orestibanos.com/ Evaluation  Experimental Setup  13 participants (65+) – no cognitive impairment reported  1 domain expert (psychiatrist)  Google Pixel, Samsung Galaxy S7, LG G5, Huawei P9 (arbitrarily provided)  Realisation of MMSE  Methods  System usability scale (SUS)  Semi-structured interview 11
  12. 12. @orestibanos http://orestibanos.com/ Evaluation  Results (SUS) 12 1-I think that I would like to use this system frequently. 2-I found the system unnecessarily complex. 3-I thought the system was easy to use. 4-I think that I would need the support of a technical person to be able to use this system. 5-I found the various functions in this system were well integrated. 6-I thought there was too much inconsistency in this system. 7-I would imagine that most people would learn to use this system very quickly. mean > 68 (good usability) [bro96] [bro96] Brooke J (1996) SUS-a quick and dirty usability scale. Usability Evaluation in Industry 189(194):4–7 8-I found the system very cumbersome to use. 9-I felt very confident using the system. 10-I needed to learn a lot of things before I could get going with this system.
  13. 13. @orestibanos http://orestibanos.com/ Evaluation  Results (semi-structured interview)  Orientation, registration and recall tasks such as questions on the participant’s current location or date “do not make a big difference with respect to the paper version, and do not pose in principle additional cognitive load to the user.”  Attention and calculation tasks are considered “quite straightforward”  Concerns regarding the feasibility of the language tasks: “I have some concerns regarding the effect that the keyboard autocorrect function can play in the naming of objects. This function appears to suggest different options that can influence the decision of the patient.” 13 [bro96] Brooke J (1996) Sus-a quick and dirty usability scale. Usability Evaluation in Industry 189(194):4–7
  14. 14. @orestibanos http://orestibanos.com/ Evaluation  Results (semi-structured interview)  Text-to-speech functionality was seen as a good feature to facilitate the comprehension of the action to be carried out. “Sometimes I have to read the questions for my patients [...], thus having them on audio seems to me very relevant. I cannot judge though how patients will feel about a device telling them to do things.”  Speech-to-text capability was highly valued by the expert: “I was somewhat intrigued with how the tool could register the voicing of a given sentence. The speech recognition functionality works surprisingly good”. 14 [bro96] Brooke J (1996) Sus-a quick and dirty usability scale. Usability Evaluation in Industry 189(194):4–7
  15. 15. @orestibanos http://orestibanos.com/ Contributions  MobileCogniTracker: a digital cognitive experience sampling tool  An integration of MobileCogniTracker with passive multimodal mobile sensing (AWARE)  A realisation of MobileCogniTracker based on the full implementation of the MMSE  A (first) study of the usability and reliability of MobileCogniTracker 15
  16. 16. @orestibanos http://orestibanos.com/ Limitations and Future work  Users experienced some difficulties with drawing and copying tasks (presumably worse for small smartphones)  Some built-in functions of smartphones could influence the answers of the users (e.g., auto- complete)  Learning effect vs. fully randomized tests  Involving cognitively impaired people 16
  17. 17. @orestibanos http://orestibanos.com/ Many thanks! Questions? 17 This work has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement #769553. This result only reflects the author’s view and the EU is not responsible for any use that may be made of the information it contains.

Editor's Notes

  • NOTES:


    ADDITIONAL TEXT:
  • World Health Assembly endorsed the Global action plan on the public health response to dementia 2017-2025. The Plan provides a comprehensive blueprint for action – for policy-makers, international, regional and national partners, and WHO – in areas such as, increasing awareness of dementia and establishing dementia-friendly initiatives; reducing the risk of dementia; diagnosis, treatment and care; research and innovation; and support for dementia carers.
  • "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses"

    Thus, the analysis of the information processing can be used to identify anomalies in the regular cognitive functioning of an individual, for example, by observing that it takes them longer than usual to think of a word or to recall a person’s name.
  • MOCA is alike the MMSE a cognitive screener, but has soms special properties in that it not only tests for normal cortical dysfunction (like memory, calculating and verbal qualities) but also for more frontal/executive functioning. Very relevant for my practice in which not only memory loss, but most of the time problems with organizing tasks, planning and impulsivity are at stake

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