(r45) C-TOCLiteratureReview < Main

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---+ C-TOC Literature Review

This page is in need of thematic re-ordering into a logical hierarchy of topic areas. Until then, it's separated into CPSC 544 topic presentation research areas, clinical psychology, and ongoing research.

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---++ HCI & Universal Usability

---+++ On universal usability (general)

---++++ [Inkpen 01]

K.M. Inkpen, "Drag-and-drop versus point-and-click mouse interaction styles for children," ACM Transactions on Computer-Human Interaction, vol. 8, 2001, pp. 1-33.

   * referred to by Joanna; potential application for !PwDs with C-TOC 

   * abstract - drag/drop + point/click interaction styles compared via field study analysis, controlled experiment, state-transition diagrams, GOMS analysis; point/click superior in terms of speed/error/preference

   * intro - some prominent user interface designs for adults may not be appropriate for children; children have difficulty w/ marquee-type selection, difficulty maintaining pressure on the mouse for extended periods; gender difference often exist with respect to interactions with computers; 
   * prev-work: dragging task was slower than a pointing task and more errors were committed during a dragging task than during a pointing task;

   * exp 1 setup: IBM version of game used point-and-click, Mac version used drag-and-drop - muscular tension req'd to keep mouse button down while dragging; both use visual feedback of object being moved during move stage; drop errors in drag-and-drop move object back to starting location; drop-errors w/ point-and-click drop at current location; 
   * goal of exp 1 - interaction style's effect on game achievement (total # of puzzles solved) and motivation (whether or not game was played for full 30min session)
   * sig.dif. in proportion of girls who were unable to solve any puzzles using the point-and-click interface and the drag-and-drop interface - 25% vs. 49%
   * sig.dif. in # of puzzles solved in each of the experimental condition: P/C: 1.66, D/D: 1.15; S/C girls more successful playing the game;
   * sig.dif in motivation in favour of S/C vs. D/D
   * discussion: enhanced realism (real game), implementation details inconsistent - may have interacted w. results

   * exp. 2 examines P/C and D/D in isolation of a game - simplified software environment, w/o possibly confounding factors, less realistic;
   * 8 dif. possibilities of distance b/w source and (2) target x (2) source size x (2) target size x (2) interaction style - each combination appeared once / trial, 16 trials / block, order of appearance of each combination was random within each block;
   * when source box picked up, visual feedback given as in exp. 1; in drop errors: S/C - source remains picked up, D/D - source returns to original position, forcing another pickup action;
   * order of interaction style counterbalanced within each gender to evenly distributer practice effects; instructed to performa task as quickly as possible w/o any mistakes;
   * dep. factors: MT, E, preference;
   * sig. main effect for interaction style in MT (S/C faster than D/D); no effect of gender; main effects for target size and target distance also significant, source size also significant;
   * sig. main effect for interaction style in E, (S/C less errors than D/D); sig. main effect of error type (mire pickup errors than drop errors), sig. interaction effect b/w type of error and source or target size, w/ size of source box sig. effecting # drop errors; no sig. main effect of errors; 
   * for pickup errors: sig. main effect for interaction style and size of source; sig. interaction of distance, only for long, not for short distances;
   * no sig. main effect for interaction style for drop errors, target size was sig., gender interacted w/ target size - interaction style was only sig. factor on # drop errors for girls, target size was sig. factor on # of drop error for boys;
   * Fitts' law analysis + linear regression: D/D - larger MTs than P/C; 
   * no sig. interaction of gender b/w preferences of girls and boys for interaction style - sig. more children preferred P/C over D/D - found P/C easier; D/D made fingers and hands tired; those who preferred D/D were familiar from using it at home; preferred the tactile feedback it provided; Buxton: kinaesthetic connectivity can help to reinforce conceptual connectivity of subtasks within a compound gesture;
   * analysed P/C and D/D using state-transition diagrams; also GOMS style analysis in terms of goals (moving source to target), operators (mouse movements and clicks), methods (interaction style), selections; D/D would be slower than P/C; D/D has an additional mouse button operation and two extra mouse movement operations; 
   * also used state-transition and GOMS models to explain observations from Exp. 1; errors made in D/D result in more operations than in P/C

   * conclusion - P/C more effective than D/D; Fitt's shows that dragging is slower and more error-prone than pointing, also effected by size of target and distance to target; children may have difficulty due to physical requirements needed to maintain constant pressure on the mouse button; research on adults: dragging task is slower and more errors made as compared to pointing task;

---++++ [Shneiderman 00]

Shneiderman B. Universal usability. Communications of the ACM. 2000;43(5). Available at: http://portal.acm.org/citation.cfm?id=332833.332843&dl=GUIDE&dl=ACM&idx=332833&part=periodical&WantType=periodical&title=Communications of the ACM.

   * Comment: This article's contribution to the field is far-reaching and addresses many forms of usability concerns. In the past 10 years, we have seen the rise of broadband internet access, the One-Laptop-Per-Child initiative (i.e. the XO-1 laptop), and the creation of many diverse online communities cited in the article. In addition, we cannot forget the rise of Web 2.0 and social networking, which have undoubtedly adhered to principles of universal usability. However, with the technical divide shrinking, a set of universal usability problems still persist today, such as concerns regarding net neutrality.

---++++ [Ho-Ching 03] - Auditory Impairments

Ho-Ching FW, Mankoff J, Landay JA. Can you see what i hear?: the design and evaluation of a peripheral sound display for the deaf. In: Proceedings of the SIGCHI conference on Human factors in computing systems. ACM New York, NY, USA; 2003:161â&#128;&#147;168. Available at: http://portal.acm.org/citation.cfm?id=642641.

   * Comment: I expect that efficient wireless microphone arrays, especially those requiring little calibration, could eventually fall within a reasonable cost range, thus enabling users to use sound visualization systems such as the Ripple display. On the other hand, I expect that ubiquitous ambient detection and notification devices may prove to be more viable, and enjoy greater use among both hearing and non-hearing users. For example, imagine a kettle equipped with the capability to send a notification over a local network to a desktop or mobile device, informing the user that water has boiled. Alternatively, sensors under doormats or inside a door detect and notify when a person approaches. If we consider Moore's law and the decreasing costs of such devices, I wouldn't doubt the possibility of a house or office containing many devices with detection and notification abilities.

---++++ [Wobbrock 03] - Motor Impairments

Wobbrock JO, Myers BA, Kembel JA. !EdgeWrite: a Stylus-Based Text Entry Method Designed for High Accuracy and Stability of Motion. In: Proceedings of the 16th annual ACM symposium on User interface software and technology.Vol 5. ACM; 2003:70. Available at: http://portal.acm.org/citation.cfm?id=964696.964703.

   * Comment: I curious as to whether a similar system exists that will support non-Roman alphabets; the Chinese alphabet for instance contains thousands of unique characters. From my understanding of written Chinese, many characters can be divided into halves or quarters (left and right, top and bottom), with more simplified glyphs in each half or corner. Perhaps an variation of EdgeWrite with a 2 x 2 grid of adjacent writing squares could facilitate input for Chinese and other languages.

---++++ [Jacko 02] - Visual Impairments

Mohan Raj, Presenter

Jacko JA, Scott IU, Sainfort F, et al. Older Adults and Visual Impairment: What Do Exposure Times and Accuracy Tell Us About Performance Gains Associated with Multimodal Feedback? CHI. 2003;(5):33-40.
   
   * Comment: It is no surprise to me that redundantly coding feedback across multiple modalities for drag-and-drop interactions is beneficial to all types of users (normal vision and impaired vision) - redundancy encoding has also been discussed at length in CPSC 533C (Information Visualization). Inspired by what was learned in that course, I am curious as to how visually impaired individuals (i.e. those with AMD) respond to animation as a form of redundant feedback. For instance, during a drag-and-drop operation of a file to a folder, it is typical for a small animation (i.e. the folder opening) to occur when the file icon is placed over the target folder. Could animations such as this, or easily-detectable animation such as a flashing icon be justifiably added to multi-modal feedback patterns for visually-impaired users?

---++++ more...

   * K.A. Moffatt, "Addressing Age-Related Pen-Based Target Acquisition Difficulties," Ph.D thesis, 2010.

   * S. Zhai, J. Kong, and X. Ren, "Speed-accuracy trade-off in Fitts' law tasks â&#128;&#148; On the equivalency of actual and nominal pointing precision," International Journal of Human-Computer Studies, vol. 61, 2004, pp. 823-856.''
      * comment: from Karyn Moffatt's thesis: documents user performance differences between five wordings of speed/accuracy task instructions for a Fitt's-like task.

   * Emery VK, Edwards PJ, Jacko JA, et al. Toward achieving universal usability for older adults through multimodal feedback. ACM SIGCAPH Computers and the Physically Handicapped. 2002;(73-74):53. Available at: http://portal.acm.org/citation.cfm?id=957214.

   * Findlater L, McGrenere J, Modjeska D. Evaluation of a role-based approach for customizing a complex development environment. Proceeding of the twenty-sixth annual CHI conference on Human factors in computing systems - CHI '08. 2008:1267. Available at: http://portal.acm.org/citation.cfm?doid=1357054.1357251.

---

---+++ On designing technology for older users

---++++ CPSC 544 - Universal Usability: Healthy Older Adults

   * [[%ATTACHURL%/544_Presentation_Universal_Usability_Health.pdf][544_Presentation_Universal_Usability_Health.pdf]]: CPSC 544 Research Topic Presentation (10/13/09)
   * [[%ATTACHURL%/544_A1_brehmer.pdf][544_A1_brehmer.pdf]]: CPSC 544 Research Topic Paper

---++++ [Goodman 03]

J. Goodman, A. Syme, and R. Eisma, "Older Adults' Use of Computers. A Survey," Proceedings of HCI 2003, 2003, pp. 12-15.

   * survey of 353 participants over 50.y.o. - highlights importance of simplicity and application's perceived usefulness;
   * method: assessed reasons for using a computer, types of computer applications used, freq. with which they were used;
   * for those with computers at home, 28% were obtained second-hand, older models, mostly PCs; when asked to provide details about their computer, only vague information given; majority rely on friends and family to choose computers for them;
   * reasons for use: shopping, family research / correspondence, internet: information access, research, shopping, email, word-processing;
      * from most to least popular in terms of application use: word-proc, internet, email, spreadsheets, databases, games, photos, music, other
      * games played by 47% of respondents (Solitaire)
   * how they learned to use computer, aside from computer classes: courses, work, self-taught, relative/friend;
      * self-teaching most common in USA, % of self-taught users increases w/ age
   * problems w/ computer use: documentation (too much jargon, inadequate support);
      * computer-literate population may not in general have a great deal of technical knowledge - complaints about complexity and jargon
   * use of internet and email decline w/ age, among internet users, popularity of email increases with age in some surveys
   * what do older people want in computer applications? most applications have obvious practical purpose; many participants motivated by perceived practical use of computer applications;

---++++ [Dickinson 07]

A. Dickinson, J. Arnott, and S. Prior, "Methods for human - computer interaction research with older people," Behaviour & Information Technology, vol. 26, 2007, pp. 343-352.

   * comment: Rock sent this article - a journal paper on working with older adults

   * HCI research rarely reflects demographic reality; important to offer techniques to researchers for attracting, retaining, and working w/ older adults; few guidelines exist to support researchers in devising appropriate methods for carrying out usability studies;
   * lifestyle:
      * wider range of educational levels, low literacy levels, many w/ no formal educational qualifications
      * cannot be assumed older adults are familiar w/ experimental techniques; silence and concentration are expected; language in consent forms, info sheets, exp. instructions must be straightforward and free of jargon; time estimates for reading must be generous, offer verbal instructions;
      * consider varying amounts of free time among older people - range of activity levels, may influence cognitive function (i.e. bereaved partners)
      * many have never used the internet; little or no direct experience w/ computers and internet;
   * sensory / cognitive changes
      * visual and auditory perception, fine motor control, memory and cognition may be affected; 
      * superior social skills - likely to involve experimenter
   * mobility issues - temporary or permanent
   * experimental design and methodologies
      * provide more time, explanation, reassurance than typical HCI experiment would allow;
      * may have uncertainty about appropriate behaviours; companions should not interfere / interrupt; participants may try to involve experimenter
      * wary about cognitive testing - age-related memory deficits - useful in ensuring equivalence between experimental groups - participants must be aware that failure is normal and expected; stress and worry can have a very negative effect on subsequent performance; hearing loss also likely to confuse, difficult to hear instructions; experimenters should not adopt stereotypical expectations about older adults' cognition
   * self-reporting: age-related processing capacity can reduce this technique with older users - confusion is often general, poorly articulated, and non-specific; inexperienced older participants may perceive difficulties as related to the keyboard; concept of alternative interfaces not easily understood;
   * thinking aloud - difficult in lab settings w/ older users - those w/ cog. impairments struggle w/ unfamiliar interfaces - thinking aloud interferes w/ completion  of exp. task; diversity of older participants: some provide excellent data when thinking aloud;
      * retrospective think aloud also limited (memory issues); think aloud description w/ re-presentation of the stimuli must be considered as contributing to user learning, therefor potentially confounding experimental results;
      * "tell-me-what-you-did" also limited - processing and memory difficulties - little remembered of recent procedures; older participants hardly remembered processes accurately until they had repeated them several times;
   * user diaries - participants rarely had attention free to complete worksheets in any great detail, unlikely to recall precise sequence of events; journaling tends to add to the interruption of the flow of daily events
      * there may also be difficulty w/ physical process of writing due to problems w/ motor control; people who have difficulty learning also least likely to provide useful information via worksheets; 
   * talking one-on-one to participants was most effective way of eliciting information, but this process tended to interferer w/ procedure itself; unlikely to find a complete solution;
   * timing: reconsider timing, be flexible, difficult in formally designed experiment;
      * difficult to time tasks accurately
      * older adults find learning about computers more difficult, likely to forget readily, take longer to attain competence then it will for younger people;
   * experimentation to be extended to allow participants to attain confidence and autonomy; learning does not follow smooth upward curve; there may be considerable frustration before a "breakthrough week" when everything falls into place; most commonly occurred between weeks 3 and 6;
   * diversity - older people are more diverse due to likelihood of illness or impairment; desirable to use a between-subjects experimental design. older participant diversity makes it important to carefully control the experimental conditions and measures; ensure ongoing access to a representative and useful sample of older people; recruitment and maintenance of varied and representative sample can only take place through making appropriate organisational decisions;
      * recruitment: bi-weekly computer classes, adverts on class website, local charities (inefficient), local media, allow direct contact with participant to allow screening - expect problems attending the university, provide support for reaching / finding the study; additional problems arise when studies are longitudinal and demand more than one visit to the university - family responsibilities, illness, operations - allow considerable flexibility in terms of scheduling sessions, allow for withdrawals, such delays are part of life experience, added ecological veracity;
   * conclusion: avoid defining older adults in terms of impairments, limitations, illnesses - superficial, stereotypical - negative impact on research;
      * small adjustments to research techniques, careful ongoing monitoring of information received, flexibility w. time and approaches;

   * see Table 1: some considerations for planning research studies involving older participants;

---++++ [Birnholtz 10]

J. Birnholtz and M. Jones-Rounds, "Independence and Interaction: Understanding Seniors' Privacy and Awareness Needs For Aging in Place," Proceedings of the 28th international conference on Human factors in computing systems - CHI '10, 2010, p. 143.

   * abstract: interview study of seniors, caregivers, relatives; how interactions, availability, privacy, independence are managed;

   * better understanding seniors' needs for ageing in place can contribute to our understanding of privacy and awareness;
   * relying upon aspects of phys. environment, temporal structures (routines), technologies to help mediate/avoid interactions

   * background / related work 
      * unobtrusive/ambient/ubiquitous sensing technologies that allow for apparent independence, sending info from the senior or their home to interested parties on a reg. basis
      * environmental sensors for unobtrusive home sensing
      * sensor info must be aggregated and displayed in a manner that allows distant caregivers and family to notice either that everything is fine, or that something may be amiss
      * ambient display systems shown to increase sense of connection/peace of mind
      * wearable devices enabling seniors to  explicitly signal trouble
      * videoconferencing b/w long-term care facilities and distant family - may be interruptive for both seniors and distant relatives
      * tension between privacy and awareness; problems mediated by sharing more detailed awareness info and allowing for virtual approaches in interaction and gradual initiation of interaction
      * attentional legitimacy: what is considered socially acceptable to pay information to in assessing others' availability
      * video and awareness info can be particularly invasive when people are in their homes (more so than in an office)
      * improving the understanding of how seniors balance their need for interaction can shed light on how to address this problem more generally

   * data analysis (grounded theory approach) - WEFT qualitative data analysis software [[http://www.pressure.to/qda/]] - MGMT of transcripts and the coding of segments of transcripts into a tree of hierarchically arranged categories

   * results
      * tangible attributes: sense of independence at home achieved through presence of familiar locations and people, ability to use attributes of environment to regulate interaction; a familiar environment gave them the option to interact w/ close friends and family on a regular basis - taking comfort in having options, interactions would happen or were possible
      * intangible attributes: familiarity and comfort: independence w/o social comfort = loneliness, remaining in a familiar environment, desire to be in a familiar environment, but opting instead to be in an unfamiliar environment with familiar people; a sense of connection to the past and a familiar environment
      * temporal structure / routines: help balance needs for independence and information; when routines violated - implicit license to inquire for more info - slightly change the balance b/w independence and interaction, violation of communication routines can serve as cause for concern; routine allows people w/ busy schedules to have a regular time then they know they will be able to interact; allows for independence while still knowing they will be able to talk to family and maintain relationships w/o straining/burdening - comfort and reassurance;
      * desire to avoid interaction at certain times; technology may help balance tension between interaction and independence, but also a source of conflict and tension
      * tension b/w independence and interaction not a continuum but a set of interdependencies;

   * implications for design
      * routine interactions - enhancing systems to support routine interaction
      * real-time interaction device when both seniors and caregivers nearby - interaction in fostering comfort, independence, peace of mind
      * sensors, ambient displays to indicate that everything is fine and available for interaction; presence in particular locations where interaction is desired


The following references were presented during a research area presentation on universal usability: healthy older adults Oct. 13, 2009.

---++++ [Abeele 06] 

Abeele V, Van Rompaey V. Introducing Human-Centered Research to Game Design : Designing Game Concepts for and with Senior Citizens. In: CHI'06 extended abstracts on Human factors in computing systems. ACM; 2006:1474. Available at: http://portal.acm.org/citation.cfm?id=1125451.1125721.

   * Abstract: UCD for non-traditional player groups such as senior citizens result in inspiring and creative game concepts based on the passions of elderly individuals.
   
   * passion model: core activity + connect, cultivate, contribute - model of passions in elderly life
   * focus on more than gameplay - cultivating personal growth, contributing to society, connecting people (ensure meaningful play)
   * co-design of game concepts for passions and desires of seniors
   * UCD in games - non-traditional player group - assessing playability in social games - incorporating ethnography and participatory design
   * PD: brainstorm around a conceptual story and passions - co-designed into paper prototype + concept
   * less important: playing cards, puzzles, TV
   * passions: people, event planning, visiting/travel, dinner, walking, cultivating knowledge, attending guest lectures, reading non-fiction, attending workshops, watching grandchildren, organising and visiting isolated/non-mobile people

---++++ [Dix 04]

Dix, A., Finlay, J., Abowd, G. D., & Beale, R. Human-Computer Interaction (3 ed.). Peason Education Limited, Essex, UK (2004). 390-391.

   * Abstract: Chapter on designing for diversity, section on designing for different age groups. Some high-level design guidelines and practices for designing for older users.

   * no evidence of technophobia among older users
   * more leisure time, disposable income, more independence in recent years (improved elder health)
   * familiarity an issue - terminology may have different meanings
   * make use of redundancy, accessibility
   * clear, simple, forgiving or errors, sympathetic and relevant training

---++++ [Eisma 03]

Eisma R, Dickinson A, Goodman J, et al. Mutual inspiration in the development of new technology for older people. In: Proceedings of Include.Vol 7. Citeseer; 2003. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.107.5588&rep=rep1&type=pdf.

   * Abstract: Presents design guidelines for working with older users and concept of mutual inspiration. Discusses value of hand-on activities.

   * early involvement, common ground, encourage discussion, focus group atmosphere, hands-on activities / workshops - build confidence, social support
   * more general than participatory design 
   * address the worries and fears of older users, but do not patronise

---++++ [Eisma 04]

Eisma R, Dickinson A, Goodman J, et al. Early user involvement in the development of information technology-related products for older people. Universal Access in the Information Society. 2004;3(2):131-140. Available at: http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s10209-004-0092-z.

   * Abstract: Methodology for early user involvement; generation of seminars regarding older users for industry.

   * communicating with industry - lack of interest - reluctant to consider older users, treated them as homogenous group - no subdivision of the demographic
   * HCI/UCD does not address problems for eliciting requirements for ICT for older users; HCI methods focus on req's for specific products / projects, but not when product has not yet been developed
   * contacting older users possible through charity orgs, educational establishments, community orgs, sheltered housing, church groups, social clubs, day centres - maintain and extend relationship - personal visits and newsletters
   * use carefully worded questionnaires, standardised UCD process
   * allow for a focus-group atmosphere (aids in individuals' lack of confidence)
   * social workshops - incorporate games, chatting, group interviews

---++++ [Harley 09]

Harley DA, Kurniawan SH, Fitzpatrick G, Vetere F. Age Matters : Bridging the Generation Gap through Technology-Mediated Interaction. In: Proceedings of the 27th international conference extended abstracts on Human factors in computing systems. ACM; 2009:4799â&#128;&#147;4802. Available at: http://portal.acm.org/citation.cfm?id=1520744.

   * Abstract: Workshop dedicated to exploring the opportunities and obstacles faced for the design of intergenerational communication. Poses questions as a means to define the current state-of-the-art and what design/accessibility/social issues factor into design for internet/mobile/pervasive technology.

   * Q: problems facing elderly people (non-health related)
   * A: social isolation, social support + companionship, loss of loved ones and peers due due death / loss of mobility, families growing distant, economic migration, existing intergenerational communication tools (familiarity issues)
   * considering intergenerational context for design
   * social isolation, social support + companionship, greater social networks - protective influence against mortality
   * decline in mobility - families distant due to economic migration
   * fastest growing user group online

---++++ [Kurniawan 05]

S.H. Kurniawan and P. Zaphiris, "Research-derived web design guidelines for older people," Proceedings of the 7th international ACM SIGACCESS conference on Computers and accessibility, ACM, 2005, p. 135.

   * Abstract: Guidleines established by group of senior users HCI experts. Senior-targeted websites reviewed using heuristic evaluation and new guidelines. A review of new guidelines with senior web-users.

   * older users using the web more: socialisation, new skill acquisition, special interests, news, personal finances, online companionship, shopping, communicating, assisting the homebound or otherwise disabled
   * categories of guidelines: vision, psychomotor, attention, memory and learning, intelligence and expertise 
   * 38 guidelines under 11 headings: target design, graphics, navigation, browser features, layout of control, links, user cognitive design, colour and background text design, search engine feedback, 
   * user evaluation of guidelines + website rating
   * conclusions: guidelines too general, not specific enough, but nevertheless implications for web developers

---++++ [Massimi 07]

Massimi M, Baecker RM, Wu M. Using participatory activities with seniors to critique, build, and evaluate mobile phones. Proceedings of the 9th international ACM SIGACCESS conference on Computers and accessibility - Assets '07. 2007;6185:155. Available at: http://portal.acm.org/citation.cfm?doid=1296843.1296871.

   * Abstract: Presentation paper. Presents list of considerations for design of mobile phones for older users. Also presents considerations for participatory design for ICT with seniors.

   * participants want a variety of functions and applications - hardware often frustrating
   * by 2050, 21% of population > 60
   * "senior-friendly" - decreased sensorimotor skills, reduction in complexity and functionality (oversimplified - appropriate for dementia)
   * discourage hasty, single-function, re-purposed solutions
   * applications: way-finding, memory aids, keyboard/mouse alternatives
   * implications for legibility - macular degeneration a reality
   * guided participatory activities - software design (needs analysis, requirements engineering, paper prototypes), needs analysis (mobile phone critiques, scenario-based design)
   * critical comments on form factor, interaction styles, aesthetics, undesirable features
   * personal organiser and memory aid - develop own phone software / main-menu redesign
   * results: function areas: calendar, address book, notebook, how-to-use-this-phone, reminder alarm, games, emergency
   * results: hardware: large buttons, screen/text size + brightness, grip, selection mechanism, jog wheel, weight, hearing aid compatibility
   * user tests / deployment: placing / receiving calls, notes, calendar, contacts, photographs, voice recorder
   * participatory design considerations: provide alternative activities, subgroups to level out individual differences and deficits, minimise cross-talk, participation as an institutional affair, activity structure, speed up / slow down as necessary, blend individual + group sessions
   * design considerations: eliminate side/rear buttons, avoid soft keys - form appropriate mental models, home state button, human support networks, several input modalities, avoid modifiers, personal data structures, no slide-out, naming conventions,
   * discussion: design for "us" rather than for "me" or "them" - less homogenous
   * limitations: may not generalise well, not guidelines but considerations - need more testing, seniors are better critics, hardware design, accessible software, lack of creativity during design (learning rather than creating)
   * conclusion: support memory to promote autonomous living

---++++ [Zajicek 04]

Zajicek M. Successful and available: interface design exemplars for older users. Interacting with Computers. 2004;16(3):411-430. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0953543804000402.

   * Abstract: Discusses usefulness of a pattern language in interaction design for older users, with an example in the domain of voice input/output web kiosk. Generalizes to all interfaces used by older users.

   * web voice kiosk case study
   * pattern language for message types
   * web applications - 1st source of info: bus schedules, council collections, doctor/hospital appts. 
   * diversity among older users - variability w/ age - dynamic diversity
   * older people ineffective when contributing to new technologies - unaware or possibilities
   * design patterns for older users - pattern language - message types: confirmatory / default / explanation
   * case study / limitations of guidelines - voice output web browser - mixed mode text + speech - evaluate usefulness of spoken instructions (voice help) - confirmatory messages to build confidence / conceptual models; what is optimal message length?
   * guidelines:
      * keep messages as short as possible
      * reduce choice whenever possible
      * use mnemonic letters to indicate key press menu selections
      * insert confirmatory statements whenever possible
   * web accessibility exemplifies dilemma inherent in use of guidelines
   * task artefact theory + claims / patterns - claims preserve info surrounding a guideline essential elements of good interface in terms of task to be completed, artefact/system or claim based on experiment or theory - encapsulate design knowledge into patterns - describing an element of design + how/why it is used - used together to enhance effectiveness; memory-supporting patterns
   * features specially designed to make interaction easier for older people will be useful for everybody - greater universal usability - user sensitive inclusive design
   * types of messages: menu choice, confirmatory, default input, context-sensitive help, talk-through, explanation, error recovery, partitioned input

---++++ [Brewster 02] - Utopia Conference

Brewster, S., & Zajicek, M. A new research agenda for older adults. Worksop held at HCI2002, South Bank University (2002). http://www.dcs.gla.ac.uk/~stephen/workshops/utopia/index.shtml (accessed Oct 2009).

   * Abstract: A workshop to establish research questions and consideration when designing ICT for older adults. 
   * motivation: increased life expectancy in developed nations: 2021 - 78 M / 83 F, 2050 - 79 M / 84 F
   * topics: social inclusion, lifestyle, user group, modelling, system design paradigm, unifying strands in interfaces / applications, age-related impairments, design guidelines, differences from universal design

Contains a link to all papers submitted:

   * 1. Dickinson A, Eisma R, Syme A, Gregor P. Utopia: Usable Technology For Older People: Inclusive and Appropriate. A New Research Agenda for Older Adults, BCS HCI, London. 2002:38-39. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Utopia:+Usable+Technology+For+Older+People:+Inclusive+and+Appropriate#0.

   * 2. Dong H, Keates S, Clarkson P. Accommodating older users' functional capabilities. Group. 2002;2:10-12. Available at: http://publications.eng.cam.ac.uk/8393/.

   * 3. Goodman J, Brewster SA, Gray P. Memory aids for older people. In: Proceedings.Vol 2.; 2002:32-33. Available at: http://www.dcs.gla.ac.uk/~joy/research/2002_pos_paper/position_paper_hci02.pdf.

   * 4. Hanson VL. Making the Web Usable By Seniors. :10-12.

   * 5. Jensen BR, Laursen B, Sandfeld J. The effect of aging on performance and muscle activity during computer use . :8-9.

   * 6. Keates S, Clarkson PJ, Robinson P. Providing Access to E-Information for Older Adults. Group. 2002:19-20. Available at: http://publications.eng.cam.ac.uk/10449/.

   * 7. King A, Kurniawan SH, Evans DG, Blenkhorn P. The Design and Evaluation of A Joystick-Operated Screen Magnifier. Group. 2002:10-12.

   * 8. Coleman R, Cassim J, Hamlyn H. It's CHI Jim, but not as we know it! Design.:34-35.

   * 9. Lines L, Hone KS. Research methods for older adults. Research Agenda for Older Adults, BCS HCI, London. 2002;(September):10-12. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Research+Methods+for+Older+Adults#8.

   * 10. Monk AF, Baxter G. Would you trust a computer to run your home? Dependability issues in smart homes for older adults. British HCI, London, UK. 2002:21-22. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Would+You+Trust+a+Computer+to+Run+your+Home?+Dependibility+Issues+in+Smart+Homes+for+Older+Adults#0.

   * 11. Morrissey W. What's Stopping Silver Surfers? The Triumphs & Challenges of Older Adults Surfing the Web. Group. 2002:14-15.

   * 12. Reed D. Towards dependability of technology assessment in the delivery of care to the elderly: a case study. Brewster, S. and Zaijicek, M. A New Research Agenda for Older Adults. British HCI, London, UK. 2002:23-24. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Towards+Dependibility+of+Technology+Assessment+in+the+Delivery+of+Care+to+the+Elderly#0.

   * 13. Wales RJ. It's a Person Issue Before a Technology Issue. Group. 2002:10-12.

   * 14. Whitney G. The Navigation of Older People with a Range of Disabilities in Complex Pedestrian Environments. :6-7.

   * 15. Wilmes B, Vogel M. Web-/kiosk-based health information on falls delivered to older people in tower hamlets. Methodology.:10-13.

   * 16. Zajicek M, Lee A. Voice XML for Older Adults' Web Access. Group.:10-12.

   * 17. Zaphiris P. Quantitative Models for Older Adultsâ&#128;&#153; Hierarchical Structure Browsing. Group. 2002:10-12.

---++++ Additional 544 References (not presented)

The following references were not presented during the topic presentation, but included in the initial research survey.

   * Ellis RD, Kurniawan SH. Increasing the Usability of Online Information for Older Users: A Case Study in Participatory Design. Computer Law. 2000;16(3):180-186.

   * Goodman J, Dickinson A, Syme A. Gathering Requirements for Mobile Devices using Focus Groups with Older People. In: Designing a More Inclusive World, Proceedings of the 2nd Cambridge Workshop on Universal Access and Assistive Technology (CWUAAT), Springer. Citeseer; 2004:1-10. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.130.7025&rep=rep1&type=pdf.

   * Kurniawan SH. An exploratory study of how older women use mobile phones. UbiComp 2006: Ubiquitous Computing. 2006:105-147;122. Available at: http://www.springerlink.com/index/R7G4V0145304J187.pdf.

   * Rosson M, Carroll J, Seals C, Lewis T. Community design of community simulations. In: Proceedings of the 4th conference on Designing interactive systems: processes, practices, methods, and techniques. ACM; 2002:75â&#128;&#147;83. Available at: http://portal.acm.org/citation.cfm?id=778726.

   * Davis H, Vetere F, Francis P, Gibbs M, Howard S. â&#128;&#156;I Wish We Could Get Togetherâ&#128;: Exploring Intergenerational Play Across a Distance via a 'Magic Box'. Journal of Intergenerational Relationships. 2008;6(2):191-210. Available at: http://www.informaworld.com/openurl?genre=article&doi=10.1080/15350770801955321&magic=crossref||D404A21C5BB053405B1A640AFFD44AE3.

---++++ more...
  
   * N. Selwyn, S. Gorard, J. Furlong, and L. Madden, "Older adults' use of information and communications technology in everyday life," Ageing and Society, vol. 23, 2003, pp. 561-582.

   * P. Gregor, A.F. Newell, and M. Zajicek, "Designing for dynamic diversity - interfaces for older people," Proceedings of the fifth international ACM conference on Assistive technologies - Assets '02, 2002, p. 151.

   * P. Gregor and A.F. Newell, "Designing for dynamic diversity - making accessible interfaces for older people," Proceedings of the 2001 EC/NSF workshop on Universal accessibility of ubiquitous computing providing for the elderly - WUAUC'01, 2001, p. 90.

   * A.F. Newell and P. Gregor, "Design for older and disabled people â&#128;&#147; where do we go from here?," Universal Access in the Information Society, vol. 2, 2002, p. 3â&#128;&#147;7.

   * J. Rowe and R. Kahn, "Successful Aging," The Gerontologist, vol. 37, 1997, pp. 433-440.

   * N. Charness, "Aging and human performance," Human factors, vol. 50, 2008, p. 548.

---

---+++ On designing technology to address users w/ cognitive/memory impairments

---++++ [Lee 07]

M.L. Lee and A.K. Dey, "Providing good memory cues for people with episodic memory impairment," Proceedings of the 9th international ACM SIGACCESS conference on Computers and accessibility - Assets '07, 2007, p. 131.

   * abstract: improved understanding of caregiver support for EMI for design of life-logging technologies, reduce burden on caregiver, allow for better care to be provided;

   * rich multimedia memory cues to help users remember their personal experiences better; performed observational study;

   * related work
      * focus on how caregivers support need for person w/ EMI for information about their past experiences;
      * reminiscence therapy for EMI; burden caregiver w. recording photos/videos for memory cues
      * lifelogging technologies - video, audio, photos; continuously record a comprehensive account of the user's experience; captured media can be indexed w/ other contextual sensor data such as GPS, accelerometer, body sensors; record when triggered by sensor - systems generate a lot of data for caregiver to sort through that may not be helpful for supporting recollection

   * study 1 - use of memory cues - 5 dyads of patients and caregivers, shadowed 4 of them - ranged from MCI to mild AD to moderate AD; attended significant events (i.e. weddings, memorials, etc.)

   * results - use of memory cues
      * caregivers engaged in dialog using cues, only when there is a reasonable chance of successful cued recall, sometimes too laborious to correct mistakes or too distressing for person w/ EMI to be corrected; caregivers usually reveal cues in piecemeal fashion until persons w/ EMI can recall rest of episode w/ their own memory; clinical evidence that engaging in such cognitively stimulating mental exercise can slow progression of cog. decline
      * question of whether technology can assist overburdened caregiver in identifying and patiently presenting good cues;

   * study 2 - identifying good memory cues
      * w/ an understanding of what good cues are, these extraction techniques can be better designed to automatically select good cues and reduce burden on caregiver
      * card-sorting technique w/ photos automatically taken by wearable digital camera; validated in a follow-up session at least one month after each experience
      * psychological models of autobiographical memory shown that info about an experience such as participants, locations, and time periods can be used as cues to retrieve generalised experience's from one's history
      * interviewed participant and asked them to reflect on what they though were good cues for memory

   * results - identifying good memory cues
      * cues must either be memorable or at least recognisable; distinctive or personally significant: people, objects, places, actions
      * qualitative differences in selection strategies and abilities b/w participants and w/ and w/o EMI
      * distinction b/w person, object, place, and action based cues and experiences - most important details of a particular experience can be represented by one type of cue, majority type cue; incidental type cues (weather, clothing worn, daily mood) not found to be important
      * detail recognised or recalled from an experience can be used as a cue to retrieve other temporarily or semantically related details of the experience
      * distinctive details, especially those different from people's normal expectations, usually more memorable than less distinct details - consistent w/ psychological understandings of distinctiveness effects in memory; can be unusual or unexpected details of the experience, helpful for distinguishing a particular experience from similar experiences that fit the same general schema; details that stand out indicating that the unexpected details are good for triggering memory; do not always have to be unusual but can be prototypical of a distinctive experience, used to recall other prototypical aspects of the experience and to remember a particularly distinctive experience
      * personal significance - richer, more deeply encoded memory trace in brain, easier for subsequent retrieval - rich recollection of experience
      * differences b/w those w/ and w/o EMI - those w/ EMI likely to be more cognitively overloaded, limit @ of cues, only use most effective cues, basic orienting cues before more specific cues, those w/o EMI can use cues that are more subtle / less central to the experience

   * discussion
      * problems: lack of rich cues in addition to caregiver's descriptions, recurring need to engage in cueing process
      * technology to reduce burden of repetitive support for episodic memory, allowing caregiver to select multimedia cues from experience and create digital narrative that person w/ EMI can review on their own to help recollect;
      * lifelogging tech usually errs on side of comprehensiveness, limited cog. resources to devote to reviewing
      * automatic summarisation techniques to reduce amount of data by extracting most effective cues; can they be identified automatically? 
      * knowing the type of experience can help determine what types of cues are most appropriate to be captures and presented to best support recollection of the experience; systems should automatically determine these; resulting in more lightweight, less invasive capture systems, less overwhelming accounts of people's experiences that are still / more effective;
      * personally significant details difficult for technology to identify - needs history of interests - caregiver intervention? sensing physiological arousal? GSR? brain-waves? potentially invasive or embarrassing to wear - not socially acceptable
      * design to leverage expertise of caregiver in identifying good cues
      * caregivers can use their own memory of experience to draw out important cues and retrieve from system by searching / browsing;
      * lifelogging to benefit those w/ EMI before condition worsens - intelligent s¥stems to use personal history to figure out what details of new experiences are distinctive or personally significant;
      * provide caregivers or users ability to delete any captured data;
      * methodology issues: variability or real-world experiences

   * conclusion
      * what is most effective modality for capturing data and presenting cues?
      * social and aesthetic issues for logging / presenting

---++++ [Sevilla 07]

J. Sevilla, G. Herrera, B. MartÃnez, and F. Alcantud, "Web accessibility for individuals with cognitive deficits," ACM Transactions on Computer-Human Interaction, vol. 14, 2007, pp. 12-es.

   * abstract: need for a cognitively accessible web; recommendations about cognitive disability are extremely difficult (if not impossible) to test; proposal of a simplified web browser and adequate web design;

   * intro: according to web content accessibility guidelines (WCAG) of the WAI, disorders such as dyslexia, dyscalculia, ADHD, intellectual impairments schizophrenia are included - participants w. barriers to participation and learning- those with intellectual disorders emphasised; within a web page with AAA qualification there is no need to use special elements which indicate to web users that they have to make a choice and, however, many people with cognitive disabilities need this info to be explicit
   * need for universal design (flexible and inclusive design, not one-size-fits-all)- same means of use for all users, provide adaptability to user's pace eliminate unnecessary complexity, use different modes for redundant presentation of essential information
   * guidelines for easy navigation design: content and navigation - avoiding excess information, provision of linear navigation, stable navigation menus, quick navigation style; supports and help - use adapted language, provide solution for errors, provide alternative supports for making comprehension easier; design and style - clear typography, alternative texts for images, control over multimedia elements
   * not to present more than 10-15 items on the same screen, make it easier for user to return to starting point
   * make content text legible and understandable, make placement and functionality of content predictable

   * cognitively accessible web proposal - focus on choice-making and browsing
   * choice making: essential for autonomous navigation and gaining access to wide and growing range of web content
   * browsing: visually showing all the stages that should be carried out to perform a task, w. image of starting and finishing point always present during performance
   * individual preferences: adapting the content to individual preferences, reducing complexity
   * design proposed: designed a specific web navigation and vis. system
      * elimination of browser menu and controls
      * use of scroll avoided
      * icons are large, descriptive text on mouse-over, horizontal and vertical alignment, alternative image on mouse over, alternative mouse pointer on mouse over
      * selection pages: show list of alternatives w/ descriptive text at top of page, audio instructions, allow user to distinguish actual options from page controls, options represented by page centred images, images are distributed around a 'selection' pictogram, large size, max # of choices = 5 (with page controls, max is 7), descriptive text of 12pt font below option images, every control has alternative text on mouse-over; selection pictogram indicated both the action to be done (choice) and the kind of page we are on - no alternative image or mouse pointer and is not clickable
      * browse pages - graphic aid emphasises the step-by-step structure idea and helps the users in the navigation process - first, last, and active step highlighted; action buttons complemented w/ additional descriptive audios created for supporting those who cannot read

   * experimental design / development - generated adapted web pages automatically by making use of web ontology parser
   * hypotheses: proposed design is usable and accessible by people w/ a range of impairments; underlying arch. of the design is appropriate for giving steps towards a testable protocol on cog. accessibility; level of usability of this adapted design is higher than the level of a typical web
   * experimental design: 2 consecutive phases - conventional vs. adapted web - N = 1 experimental design w/ 20 replications
   * specified goals with effectiveness, efficiency, and satisfaction - ad hoc measure of usability that includes measures of its components - also measured the interaction of the individual with cognitive impairment w/ accompanying teacher in order to complete the comparison study between the adapted and conventional version
   * participants - those w/ mental retardation - cannot be generalised to whole spectrum of individuals with cog. deficits;
   * results: adapted version found to be much more usable, no difference in satisfaction, no difference in interaction w/ teacher
   * correlation of -0.473 between IQ and scores on web understanding, w/ adapted version no correlation b/w IQ and scores of any measures of usability

   * discussion - is it necessary to have different levels of cog. accessibility?
   * all participants had better performance on adapted version - level of mental retardation not most appropriate scale for determining levels of cog. accessibility
   * adapted version very repetitive and boring due to reduced # of choice
   * further investigation required into specific cog deficits - matter learning to navigate the web / matter of performing the navigation

---++++ [Hawkey 05]

K. Hawkey, K.M. Inkpen, K. Rockwood, M. !McAllister, and J. Slonim, "Requirements gathering with Alzheimer's patients and caregivers," Proceedings of the 7th international ACM SIGACCESS conference on Computers and accessibility - Assets '05, 2005, p. 142.

   * abstract: alleviating repetitive questioning behaviour

   * intro: current guidelines - writing the answer down and directing the !PwAD to the written answer; having them find the answer for themselves; providing reorientation with written reminders, signs, clocks, calendars, whiteboards, as well as through familiar objects and memories; misleading or distracting them if the true answer could cause distress
   * explored dimensions of repetitive questioning in an effort to provide a user and needs analysis for a proposed technological intervention for the problem; interested in whether or not those w/ AD would be willing to use technology, the barriers to use the technology for this population, effectiveness of technology at relieving some of the caregiver stress associated with repetitive questioning behaviour;

   * repetitive questioning study: what are the information needs of AD patients? what are their best modes of interaction? how can we provide information in a manner that is timely, informative, relevant? how can caregiver input the info w/ less stress and effort than answering the !PwAD's questions?
   * multi-method approach: diaries, semi-structured interviews;

   * results: primarily inductive analysis approach
   * information needs: time (concept of time for AD patients seems to change); schedule (TV schedules not used), reminders limit independence, but ay be helpful, limit advance notification of an event to reduce questioning - family gatherings should be known far in advance; current event details, information (i.e. misplaced items, recent history, brief biographies w/ photos of people; opinions / feedback - reinforcement questions;
   * interaction abilities: not able to use a computer by themselves, mechanical interactions and remotes too complex, difficulty w/ the telephone; problems initiating activities, linguistic difficulties - reading absorption and comprehension, following a plot; stopped writing or are writing unintelligibly; generally found to have intelligible speech - difficulty coming up with right word, forming complex questions, difficulty understanding, problems w/ pronunciation;

   * discussion: fluid reality of AD patients; denial vs. face-saving; competing interests of !PwADs and CGs; !PwAD not only trusts the device to give wanted information, but also must understand the information; those w/ mild AD or MCI would have need for more detailed info
   * feasibility: need to satisfy various info needs in various settings; interaction abilities constrain the device; should be able to answer most questions of !PwAD; time and schedule info; context about event underway (context and location-aware; item location (sensor technology), moveable within the home / outside the home? opinions and feedback, rules that require reasoning, list of steps to complete common items; 
   * mechanical skills - eliminate chance for errors; most basic of interactions, direct input (touch), speech may be difficult (declining language abilities, difficulty in remembering words), barriers to complexity and anxiety about technology is common among elderly, exacerbated among !PwDs; perhaps introduced during earlier stages of memory decline? important that device does not resemble a computer; needs to always be on / ready to use; method of gaining attention required; interface design will be challenging; willingness of caregiver to maintain? effective enough at lessening the questioning behaviour to justify burden of maintaining the information (CG); 

   * conclusion: info applicant to reduce repetitive questioning likely to fail - must introduce at appropriate phase, keep level of detail appropriate for that phase;

---++++ [Wu 08]

Zoltan Foley-Fisher, Presenter

Wu M, Birnholtz J, Richards B, Baecker RM, Massimi M. Collaborating to Remember: A Distributed Cognition Account of Families Coping with Memory Impairments. Memory. 2008:825-834.

   * Comment: Given the design considerations documented in this article, it appears as though many of them can be satisfied with existing services and technology. Google calendars allows users to share, set owner and group rights, and edit calendars from the web or on a mobile device. A group with Windows Mobile-equipped devices can synchronize their Exchange calendars and set reminders for individuals or for the entire group. The cost of large displays (and potentially even large wall-mounted touch displays) will come down in eventually come down and facilitate editing of synchronized shared calendars at home. One component of this solution that is currently missing is ubiquitous or wearable computers with synchronous capabilities, but I suspect that even these forms of technology are not far from being realized.

---++++ 544 Topic: Cognitive Impairments 

Zoltan Foley-Fisher, Presenter

   * Back M, Szymanski MH. The !AirBook: force-free interaction with dynamic text in an assistive reading device. In: CHI'01 extended abstracts on Human factors in computing systems. ACM; 2001:251â&#128;&#147;252. Available at: http://portal.acm.org/citation.cfm?id=634216.

   * Dawe M. Desperately seeking simplicity: how young adults with cognitive disabilities and their families adopt assistive technologies. In: Proceedings of the SIGCHI conference on Human Factors in computing systems. ACM; 2006:1152. Available at: http://portal.acm.org/citation.cfm?id=1124772.1124943.

   * Lee ML, Dey AK. Lifelogging memory appliance for people with episodic memory impairment. Proceedings of the 10th international conference on Ubiquitous computing - !UbiComp '08. 2008:44. Available at: http://portal.acm.org/citation.cfm?doid=1409635.1409643.

   * !LoPresti EF, Mihailidis A, Kirsch N. Assistive technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation. 2004;14(1):5â&#128;&#147;39. Available at: http://www.informaworld.com/index/789064993.pdf.

---++++ more...

   * R.M. Baecker, "Designing technology to aid cognition," Proceedings of the 10th international ACM SIGACCESS conference on Computers and accessibility - Assets '08, vol. 2020, 2008, p. 1.

   * M. Balaam, A.M. Hughes, S. Rennick-Egglestone, and T. Nind, "Rehabilitation Centred Design," CHI 2010, Atlanta: 2009, pp. 1-4.

   * J. Bauchet, H. Pigot, S. Giroux, D. Lussier-Desrochers, Y. Lachapelle, and M. Mokhtari, "Designing judicious interactions for cognitive assistance," Proceeding of the eleventh international ACM SIGACCESS conference on Computers and accessibility - ASSETS '09, 2009, p. 11.

   * S. Carmien, "End user programming and context responsiveness in handheld prompting systems for persons with cognitive disabilities and caregivers," CHI '05 extended abstracts on Human factors in computing systems - CHI '05, 2005, p. 1252.

   * M. Pollack, "Autominder: an intelligent cognitive orthotic system for people with memory impairment," Robotics and Autonomous Systems, vol. 44, 2003, pp. 273-282.

   * H. Kautz, L. Arnstein, G. Borriello, O. Etzioni, and D. Fox, "An overview of the assisted cognition project," AAAI-2002 Workshop on Automation as Caregiver: The Role of Intelligent Technology in Elder Care, 2002, p. 60â&#128;&#147;65.

   * M. Morris, J. Lundell, and E. Dishman, "Catalyzing social interaction with ubiquitous computing: a needs assessment of elders coping with cognitive decline," CHI'04 extended abstracts on Human factors in computing systems, ACM, 2004, p. 1154.

   * Schulze H. MEMOS: An Interactive Assistive System for Prospective Memory Deficit Compensation. Proceedings of the 6th international ACM SIGACCESS. 2004:79-85. Available at: http://portal.acm.org/citation.cfm?id=1028645.

   * Carmien SP, Cavallaro FI, Koene RA. Ê»Senior MomentsÊ¼ : Loss and Context. In: Proceedings of the 2nd International Conference on Pervasive Technologies Related to Assistive Environments. Corfu, Greece; 2009:0-3.

   * Voinikonis A, Irmscher K, Schulze H. Distributed processing of reminding tasks within the mobile memory aid system, MEMOS. Personal and Ubiquitous Computing. 2005;9(5):284-290. Available at: http://www.springerlink.com/index/10.1007/s00779-004-0332-5.

---

---+++ On designing technology to address users w/ dementia

---++++ [Wherton 08] - IDRG 05.18.10

J. Wherton and A. Monk, "Technological opportunities for supporting people with dementia who are living at home," International Journal of Human-Computer Studies, vol. 66, 2008, pp. 571-586.

   * abstract
      * grounded theory analysis of interview transcripts with dementia patients + caretakers; discussed ADLs: dressing, taking medication, personal hygiene, preparing food, socialising; design challenges for flexible prompting systems sensitive to intentions, capabilities, values of users;

   * intro
      * problem domain - users w/ impaired episodic memory, parallel deficits in exec. function; past efforts to address this area in pervasive computing + sensing have involved computer vision, RFID tags; affecting ADLs
      * exec functioning: sequencing, omissions, action additions, concurrent task performance;
      * impairment to attentional control processes - problems more likely w/ novel procedures; occupational therapy solution: procedural memory stimulation, environmental cues to support action, independence achieved through environmental manipulations, making task-relevant items more visible
      * stress need of naturalistic methods of assessment
      * temporal and spatial orientation: visual cues - flowcharts, calendars; reality orientation therapy - use of large signposts, signs on drawers and cupboards + verbal prompts + cues; extended w/ use of technology - large digital clocks; ENABLE project: activity compass, portable orientation + GPS, verbal prompts to return home;
      * prompting actions: prompt at designated times to support schedule keeping, sensors to guard against accidents;
      * less clear what people w/ dementia and their caregivers want from the technology - what tasks are most important to them? what difficulties are most hard to find non-technological workarounds for? what tasks would their caregivers rather not do for the people they care for?

   * study rationale + method
      * 2 small sample interview (opportunistic) - #1 w/ OTs and care workers (20 participants - 11 in focus group, 9 interviews); #2 w/ 18 participants (8 !PwDs, 10 caregivers) in home environments; studies not methodologically equivalent, but maximally informative; grounded approach to characterise data - to elicit ideas for technological interventions; concepts grouped to from main categories and component sub-categories (axial coding)

   * results - study 1 - fig. 1
      * problems in the home: daily activities (dressing, medication, food/drink, washing, toilet), risks (cooker safety, wandering), interpersonal interaction (communication, recognising people);
      * underlying deficits: sequencing (initiating and ordering actions, problem solving), learning (appliances, surroundings), memory/orientation (forgets events, forgets to do things, orientation to time/place, recognising objects)
      * consequences: !PwD: physical wellbeing (safety, security, health), control (personal space, achievement, social isolation), caregiver: patient-caregiver relationship: relationship (interaction, frustration), care demands (constant supervision, anxiety)
   * results - study 2 - fig. 2
      * problems in the home: daily activities (dressing, medication, food/drink, washing, toilet), domestic (washing-up, locking-up, ironing, cleaning), leisure (TV, loss of interests) (not mentioned in study 1), interpersonal interaction (conversing, telephone, appointments);
      * situated factors: verbal cues (prompts, notes), visual cues (display items, items visible), familiarity (surroundings, appliances, routines);
      * underlying deficits: sequencing (formulating procedures, becomes motionless), memory/orientation (forgets events, forgets to do things, locating items, knowing the time, finding their way)
      * consequences: !PwD: physical wellbeing (safety, security, deterioration), control (personal space, stress, filling time - boredom), caregiver: patient-caregiver relationship: relationship (confrontation, frustration), care demands (tiredness (not among professional caregivers), worry)

   * discussion
      * high-level characterisation of results useful for engineers and others new to the area
      * extracted parts of the transcript: suggestions for technological interventions

   * discussion - dressing
      * *no existing products to help one get dressed*
      * provide prompts?
      * how to monitor state of dress of !PwD? RFID tags?
      * have items been put on appropriately? *appropriate choice of clothes for season / occasion?*

   * discussion - medication
      * tools exist to automatically dispense medication appropriately
      * has medication been swallowed?
      * call-centre operative to call throughout the day?
      * *ripe for future research*
      * intelligent toilets for monitoring medication compliance?

   * discussion - food and drink
      * cooker safety (i.e. leaving on the stove)
      * cooking tasks too complex to manage alone
      * problems in making a hot drink - for oneself and for visitors (self-esteem issue and sense of personal role + status)
      * safety:
         * cooker: lockable gas shut-off for detecting emergencies in kitchen such as extreme temperature? - rely on automated feedback from !PwD / caregiver;
         * can pervasive computing techniques be used to infer how an incident arose and choose between alternatives
         * call centre operator? 
         * dangerous for use w/ some !PwDs
      * prompting + preparing:
         * no commercially available systems for prompting through process of multi-step task such as making a hot drink; *clear objective for research*
         * *RFID utensils? large screen in kitchen cupboards?*
         * *how to detect completed actions? how to prompt?*
      * *measuring quantities (i.e. baking)?*

   * discussion - washing
      * automatic water shut-off?
      * system exists for prompting through hand-washing process? detecting when actions out of sequence;
      * *showering? bathing? brushing teeth? grooming?*

   * discussion - toilet
      * *massive research agenda here* - flexible automated systems that are acceptable to !PwDs;

   * discussion - possibilities for support w/ technology:leisure + interpersonal interaction
      * difficulty in recognising and communicating w/ others - detrimental effect on social interaction and maintenance of social networks;
      * !PwDs show decline in personal interests
      * limitations on socialising and entertainment lead to feeling of loneliness and boredom
      * design issue: safety has been higher priority than product development; 
      * recreationally oriented technology - "social memory aid"
      * MS !SenseCam - life-logging
      * leisure and socialising: *have not yet found a niche for older people or !PwDs*

   * discussion - possibilities for support w/ technology: preventing and mitigating consequences
      * devices may alert a call centre or relative if they leave the dwelling
      * uncertain about guests: if nervous about a caller, householder can alert the call centre who can advise them what to do and if necessary record the ensuing conversation;
      * recording the activities of elder living alone using sensor technology - provide peace of mind for extended family living in a remote home?
         * reducing the anxieties of informal caregivers when !PwD is left alone
      * communication rather than monitoring? more acceptable way of providing assurance needed by !PwD and caregiver - *privacy for ageing in place*

   * discussion - constraints on design
      * !PwDs and technology
      * adapting to new appliances, environments, routines
      * *problems w/ novelty* - optimise user familiarity, make perceptually similar to other devices, attaching device to appliances already owned by !PwD - familiarity can only be achieved up to a certain point;
      * evidence that people w/ severe dementia can cope w/ novel interactions and technology
      * present affordances for action - do what the message says, touch this picture), does not require learning of multi-step procedures; provide visual cues; Norman: different visual representations can implicitly guide the user's actions and can be justified by psychological theory;
      * exploit *visual and tactile cues*? 

   * conclusion
      * collection of challenges to tech. designers
      * contextual account of everyday problems; captures POV of !PwD and informal caregivers

   * IDRG discussion points:
      * curb-cut effects?
      * opportunities for haptics? affect loop? large-screen displays? table-top displays? robotics? mobile devices? machine learning? intelligent user interfaces?
      * implications w.r.t. privacy for ageing in place?
      * avoiding call-centre interventions?
      * designing interactive software for desktop / laptop / tablet computers
         * communicating / keeping in touch
         * access to information
         * word processing
         * games
      * methodology issues
         * grounded theory analysis

   * IDRG comments:
      * monitoring vs. communication (distributed family awareness) - Gokhan
      * see Georgia Tech (Tran et al reference) - Kelly
      * reminiscing (CHI paper) - Mohan  

---++++ [Topo 09]

P. Topo, "Technology Studies to Meet the Needs of People With Dementia and Their Caregivers: A Literature Review," Journal of Applied Gerontology, vol. 28, 2008, pp. 5-37.

note: ISG reference - not immediately relevant to HCI

   * analysis of 66 studies of interventions for people with dementia
   * those that take into account impact of technology, impact of personal characteristics of !PwDs, impact of fCG, impact of environment, impact of research process and researchers
   * refs to follow-up on: [Baruch, Downs, Baldwin, Bruce 2004], [Labelle and Mihailidis 06], [Schreiber 98]
   * discussion: bias towards residential care and moderate stages of dementia, emphasis on safety issues and CG well-being; little to alleviate social isolation
   * not RCTs of !PwDs living at home, very limited # of assessment studies focused on supporting the independent living of people w/ dementia
   * only peer-reviewed journals queried, defining search terms difficult, defining technology difficult

---++++ [Mihailidis 07]

A. Mihailidis, J. Boger, M. Canido, and J. Hoey, "The Use of an Intelligent Prompting System for People with Dementia," interactions, 2007, pp. 34-37.

   * prompting device that uses AI to automatically monitor an older adult in a self-care facility - four integrated systems: tracking, state monitoring, Markov decision process (MDP) policy, prompting modules
   * ref: Issue 10 of IEEE transactions on information technology in biomedicine
   * levels of prompting specificity were minimal ("use the towel"), moderate ("use the blue towel"), specific ("John, use the blue towel on your right")
   * inclusion criterion was clinical diagnosis of moderate to severe dementia - modified withdrawal-type single subject research design
   * DVs: number of hand-washing steps that the participant completed without any interaction with a caregiver, number of interactions between the human caregiver and the participant for successful completion of hand-washing
   * observed that this participant's level of dependence on the caregiver decreased when the device was introduced, increased when device was removed: potential decreased in caregiver workload
   * participant ignored a large percentage of prompts from the device, not able to fully understand directions being given - responded positively to only 6% of the them, five or more prompts from the system were often required before she responded properly or the caregiver was required to enter and assist her, especially during the "use the soap" step

---++++ more...

   * J. Wherton and A. Monk, "Choosing the right knob," Proceedings of the 27th international conference extended abstracts on Human factors in computing systems - CHI EA '09, 2009, p. 3631.

   * J. Wherton and A. Monk, "Designing cognitive supports for dementia," ACM SIGACCESS Accessibility and Computing, 2006, pp. 28-31.

   * R. Orpwood, C. Gibbs, T. Adlam, R. Faulkner, and D. Meegahawatte, "The design of smart homes for people with dementia: user-interface aspects," Universal Access in the Information Society, vol. 4, 2005, pp. 156-164.

   * Jones K. ENABLE Report: enabling technologies for people with dementia: Report of the assessment in ENGLAND. Quality. 2004;(January).

   * Holthe T, Engedal K. ENABLE Report: enabling technologies for people with dementia: National Report on Results From Norway. Information Technology. 2004;15(3).

   * Topo P, Saarikalle K, Maki O, Parviainen S. ENABLE Report: enabling technologies for people with dementia: Report of Assessment Study in Finland. Proceedings of the... annual Conference on Rehabilitation Technology. 2004.

   * Boger J, Hoey J, Poupart P, et al. A planning system based on Markov decision processes to guide people with dementia through activities of daily living. IEEE transactions on information technology in biomedicine : a publication of the IEEE Engineering in Medicine and Biology Society. 2006;10(2):323-33. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16617621.

---

---+++ On task interruption + resumption

---++++ [Salvucci 10]

D.D. Salvucci, "On reconstruction of task context after interruption," Proceedings of the 28th international conference on Human factors in computing systems - CHI '10, 2010, p. 89.

   * resumption not as a primarily memory-based process, but rather one of reconstruction - perceptual re-encoding of the information necessary to perform the task

   * research grounded in cog.psyc. aimed to elucidate cog. underpinnings of task suspension and resumption, focusing on resumption as memory-based process: memory for goals, interrelated encoding and retrieval processes
      * measure using resumption lag - time needed to resume primary task - higher in applied studies, often making memory-based accounts difficult or implausible, almost certainly involving more than a single memory retrieval
   * theoretical framework for thinking about task resumption as process of reconstruction, requiring visual re-encoding to reconstruct task context immediately prior to interruption

   * ACT-R model - integrates various sub-theories of human cognitive, motor, and perceptual processes - knowledge as declarative chunks of information, procedural rules, framework to develop computational models of user behaviour and to measure behaviour and performance; mental resource known as problem state; most tasks do require the creation and updating of problem state during the execution of a task - a distinct mental resource
      * implications for understanding of task interruption and resumption; problem state can only be maintained for a single task at a time, at interruption, user stores away the current task's problem state and replaces it with a new problem state for the interrupting task - eventually retrieve the original task's problem state
      * memory decay will, over time, make problem-state information difficult or impossible to recall - failure to recall problem state leads to reconstruction of the problem state or a replication of the lost problem state, involves re-reading text, scanning paper notes, phoning someone for information, domain dependence of reconstruction process

   * illustrative models of reconstruction - two tasks used in recent studies on interruption - route-planning and document-editing, interrupted by news-reading task in which they read a news article and decided on an appropriate title for the article
   * determined "best" and "worst" possible points of interruption
   * task analysis was conducted to determine the reconstruction and action steps are needed to recover the pre-interruption problem state; ACT-R used as it allows for better generalisation to broader theories of multitasking
   * resumption lag represents the time needed to perform the first observable action in the primary task, and thus includes reconstruction as well as subsequent actions until the point of this first observable action
   * straightforward analysis of reconstruction steps leads to a good estimate of behavioural measures: reconstruction can be a large piece of the total resumption lag

   * discussion: domains involving a long interruptions and/or complex mental states are the most likely to rely on reconstruction; but no easy domain-general way of specifying the reconstruction processes
   * memory and reconstruction based resumption processes are not mutually exclusive - reconstruction process may involve cueing of relevant memories by the external environment


---++++ more...

   * Tran Q, Calcaterra G, Mynatt E. How an Older and a Younger Adult Adopted a Cooking Memory Aid. Proc. Human-Computer Interaction International (HCII). 2005. Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.78.3784&rep=rep1&type=pdf.

   * !McFarlane D, Latorella K. The Scope and Importance of Human Interruption in Human-Computer Interaction Design. Human-Computer Interaction. 2002;17(1):1-61. Available at: http://www.informaworld.com/openurl?genre=article&doi=10.1207/S15327051HCI1701_1&magic=crossref||D404A21C5BB053405B1A640AFFD44AE3.

   * M. Czerwinski, E. Horvitz, and S. Wilhite, "A diary study of task switching and interruptions," Proceedings of the 2004 conference on Human factors in computing systems - CHI '04, vol. 6, 2004, pp. 175-182.

   * D.D. Salvucci, N.A. Taatgen, and J.P. Borst, "Toward a unified theory of the multitasking continuum: From concurrent performance to task switching, interruption, and resumption," CHI 2009, 2009, pp. 1819-1828.

   * Nagel KS, Hudson JM, Abowd GD. Predictors of availability in home life context-mediated communication. Proceedings of the 2004 ACM conference on Computer supported cooperative work - CSCW '04. 2004;6(3):497. Available at: http://portal.acm.org/citation.cfm?doid=1031607.1031689.

---+++ On Prospective memory (PM) and interruption/distraction

---++++ [Farrimond 06]

Farrimond S, Knight RG, Titov N. The effects of aging on remembering intentions: performance on a simulated shopping task. Applied Cognitive Psychology. 2006;20(4):533-555. Available at: http://doi.wiley.com/10.1002/acp.1202.

   * abstract: task measuring memory for delayed intentions - memory search but not cue detection affected in older persons, no age specific effect on cue detection, capacity for self-initiated reinstatement of working memory is reduced in old age

   * intro: Henry et al 2004 confirms that prospective memory is impaired in old and and that is is particularly evident on tasks that required effortful or strategic processing
   * older persons specifically impaired on memory and attentional tasks that rely on effortful, conscious or controlled processing;
   * Henry et al 04 found that older groups superior to younger groups on naturalistic time-based tasks, decline on laboratory tasks
   * examined three aspects hypothesised to be sensitive to age: opportunity to learn instructions, familiarity with environment, presence of distractions; distinction b/w process of recognising a cue and recalling associated action (relies on self-initiated memory search)
   * number of instructions and length of testing sessions kept at reasonable level

   * study 1: Einsteing et al 97, Light et al 00, !McDermot 04: older adults reduced capacity to make effortful searches through memory; memory search sometimes automatic when a strong contextual connection exists b/w cue and instruction (i.e. buy coffee at starbucks); sometimes cue is identified without conscious awareness; 
   * ability to control activity may compensate for reduced ability of older group to complete prospective tasks
   * either one or three learning trials (cue and associated task) - hypothesised that 1-trial group would have disproportionate negative effect for older participants on more effortful process of recalling actions relative to their ability to recognise cues;
   * virtual street used - speed with which they move along street recorded, and time on each page; cannot go backwards
   * expected to recall task aloud in response to cue - correct action recorded
   * 3 factor ANOVA - age x # learning trials x task component (RM - cue and task); sig. main effect for  age, # learning trials, component, learning trial and component interaction, component x age interaction, age x learning trial x component interaction approached significance, time significant for age, not slower in 3-trial condition, no significant age x learning trial interaction, both groups more efficient when they had 3 learning trials
   * older group less likely than younger group to recall task associated with cue, older group more affected than younger group when only had 1 learning trials; reduced opportunity for encoding, self-initiated memory search more difficult
   * superiority of memory recall in younger persons, enhanced ability to learn instructions, older persons can perform as well as younger group when given enhanced opportunity to learning instructions. 
   * older persons tended to be about 3-4 min slower

   * study 2: determine whether recognising cues and associated task is more difficult in unfamiliar environment for older people than younger people; assess how ageing affects vigilance and remembering in unfamiliar naturalistic environments
   * possible that unfamiliar target would be easier to detect than familiar one; Einstein 90, !McDaniel 93: unfamiliar words have been found to produce more reliable prospective remembering than familiar ones; 
   * also interested in # of instructions they were likely to remember, older people have more realistic appreciation of what they are likely to remember
   * procedure used was same as in first study, except no practice session
   * 3-factor ANOVA - age x familiarity x component (cues vs tasks RM); significant age and component main effects, no effect of familiarity, significant component x group interaction; older persons have more difficulty recalling actions than cues relative to younger group
   * significant age effect for time/page, no familiarity effect, no age effect for page/location; suggested that participants tended to be less efficient in their movements around the unfamiliar street
   * participants in both groups underestimated how much they would remember, trend towards the participants predicting a poorer performance in the unfamiliar street
   * older persons not affected by unfamiliarity of the environment, neither speed nor accuracy of cue detection affected; environment might not have been sufficiently alien to cause differences in attentional strategies
   * younger group was significantly more conservative in estimates of what they would actually achieve than the older adults, expectations of remembering shopping instructions do not decline with age

   * study 3: examined effect of distractions and interruptions on the shopping errands task; prompted by findings that older persons are more affected by irrelevant stimuli than younger persons in complex visual search environments (Carlson 95, Morrow 92, Plude 86, Rabbitt 65) - inability to inhibit irrelevant inputs (Hasher 88)
   * West 99 - momentary lapses in intention; brief lapses in vigilance rather than an inability to remember task instructions; brief delays in opportunity to execute an intention caused deficits in performance of older adults
   * interrupted by having a conversation with another person - introducing 4 verbal fluency tasks during the movement down the street; memory load has been shown to affect memory for intentions in older persons; hypothesised that older persons would display a deficit in the reinstatement of working memory for the shopping task
   * 2-factor, condition (distraction, interruption, control) x age group ANOVA; significant age and condition main effects - ability for older group to detect cues in interruption condition was significantly reduced; only significant differences were for the older group, between the control and interruption conditions and the distraction and interruption conditions; ANOVA conducted for probability of recalling the tasks correctly - only sig. main effect was age; time/page data ANOVA - age was significant; no evidence that older group slowed their time of inspection per page to compensate for presence of any additional distraction; age by condition interaction - control group accessed more pages for each location correct than either the distraction or interruption groups;
   * irrelevant visual and auditory distraction to the situation had little effect; relatively easy for participants to inhibit this auditory modality, since it is clearly not relevant to the shopping task, which relies on visual cues
   * interrupted subsequently less likely to notice cues in the street; condition-specific impact on recall; if cue was noticed then probability of remembering the associated action was unchanged; recognising cues on the other hand is dependent on conditions that arise in the environment;
   * !McDaniel 03, Einstein 00 - brief delays b/w cue recognition and opportunity to act impair older persons' performance; older persons report difficulty remembering what they were doing before they were interrupted

   * discussion - older persons have difficulty remembering intentions, even when environment and tasks are familiar and they can move at their own pace;
   * older persons were specifically impaired in the memory search component of the task relative to detecting cues; recall more effortful than attentional processing in this situation; self-initiated memory search is impaired in old age; 
   * familiarity had no effect on accuracy or speed of movement for young/old persons
   * older persons not specifically disadvantaged when asked to recognise a relatively small number of distinct cues in an environment that, although unfamiliar, is within their range of experience
   * older persons responded by blocking out distractions, where the distraction could not be ignored, ability of older persons to notice cues was significantly disadvantaged, although meta-strategy was intact; this had the effect of disrupting the prospective vigilance or monitoring component of the task, while having no specific effect on the memory search component
   * older persons may be aware that memory generally declines with age, translating this into a realistic expectation of performance on a specific or a novel task to be difficult
   * limitation: time frame of the task (1 hr);
   * future work: allow strategic planning, move backwards and forwards
   * circumstances where attentional and memory strategy are self-determined, likely that kind of difficulties that come with age or are inflicted by brain injury will become more pronounced
 
---++++ [Einstein 90]

Einstein GO, !McDaniel MA. Normal aging and prospective memory. Journal of experimental psychology. Learning, memory, and cognition. 1990;16(4):717-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/2142956.

   * abstract: subjects given prospective memory test, 3 tests of retrospective memory; no age deficits in prospective memory, no reliable relation between the prospective and retrospective memory tasks; external aids and unfamiliar target events benefit prospective memory performance; results suggest some basic difference between prospective and retrospective memory

   * intro: prospective memory (PM) is memory task that requires the greatest degree of self-initiation; typical procedure used to study PM has involved asking subjects to perform some action in naturalistic settings; age-related deficits in PM may not emerge in these settings because subjects may use external cues to help guide retrieval

   * experiment 1: lack of an accepted experimental paradigm for studying PM; laboratory method needed for studying PM; compared PM of young/old subjects, varied whether or not they were allowed to create/use an external memory aid
   * 2 (age, BS) x 2 (opportunity to form an aid) BS factorial design; PM test embedded within short-term memory task; subjects in external-aid condition given 30s to formulate some type of aid;
   * 2x2 BS-ANOVA: retrospective memory, free recall - main effect of age, no effect of memory-aid, no interaction; similar results w/ recognition test; in STM performance, older subjects recalled a greater proportion of word sets than did younger subjects (main effect of age), no effect of memory-aid, no interaction
   * PM performance - no effect of age on PM, main effect of memory aid, using an aid -> higher PM score, no interaction;
   * most of those in memory aid condition used piece of paper taped to CRT
   * relations b/w RM and PM: multiple regression analysis; PM related to memory aid, not related to performance on any RM task
   * subjects tended to think about PM task more often during word set presentation than in other phases, elderly subjects admit that they thought less about the PM task than young subjects, this behaviour highly correlated with prospective remembering
   * results run counter to view that PM should be especially problematic for older subjects; either memory deficits in elderly are not entirely due to problems in self-initiated retrieval, or certain kinds of prospective memory situations incorporate or have retrieval cues embedded in them

   * experiment 2: test again effects of age on PM, test idea that retrieval cues are present and play a role in certain PM tasks
   * successful PM depends on triggering of action by target event; PM should be better with an uncommon and unfamiliar target event than with a common and familiar target event; 1/2 subjects asked to press a response key whenever a familiar target event occurred, other 1/2 to press on unfamiliar target event (familiar/unfamiliar words)
   * 2 (age) x 2 (familiarity) between-subjects factorial design
   * RM performance: free recall reliable effect of age; STM performance - main effect of age;
   * PM performance - PM was nearly 3 times higher w/ unfamiliar target than w/ familiar; no effect of age or interaction; PM performance not reliably associated with performance on any RM tasks; 
   * subjects thought more about PM task during presentation of word sets than during other phases, familiarity x phases interaction; unfamiliar target events increased monitoring ratings relative to familiar target events but only during word-set presentation; neither main effect of age or interactions reliable
   * correlations performed b/w monitoring ratings during each phase and PM performance; monitoring ratings during presentation of word sets highly correlated w/ PM performance

   * discussion - major finding was lack of age-related deficits in prospective memory; PM seems to be an exciting exception to typically found age-related decrements in memory; reliable age differences in RM
   * problem with studying PM in laboratory setting is that demand characteristics could lead subjects to continuously rehearse PM task, an unrealistic PM situation; PM performance was not at ceiling (61% across all subjects)
   * no indication that successful PM came at expense of short-term memory performance;
   * failure to find age-related differences  in PM is that elderly were more motivated than young to perform memory tasks; nonetheless, possible that elderly, relative to the young, saw the prospective memory task as more important and thought about it constantly; [Craik 86] theory that ageing mainly disrupts self-initiated retrieval processes; PM should be especially difficult for elderly because it requires person to remember to remember; 
   * questionable assumption that all PM tasks are alike in the sense that they are high in self-initiated retrieval, PM tasks vary in the degree to which they require self-initiated retrieval processes for successful memories;
   * event-based PM tasks might not produce large age-related effects because  they contain external cues; time-based PM tasks that involve more self-initiated retrieval than event-based tasks, might be more likely to produce large age-related deficits;
   * no obvious relations b/w RM and PM; 
   * event-based target events not likely to be thought of as PM stimulus;
   * w/ familiar target events, competing associations would be more likely to interfere with PM;

---++++ [Einstein 00]

Einstein GO, !McDaniel MA, Manzi M, Cochran BM. Prospective memory and aging: Forgetting intentions over short delays. Psychology and Aging. 2000;15(4):671-683. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Prospective+Memory+and+Aging+:+Forgetting+Intentions+Over+Short+Delays#0.

   * abstract: age-related PM decrements often dramatic when retrieval was facile; when initial retrieval difficult, older adults showed no forgetting over retention interval

   * intro: researchers have found reliable and even substantial age differences in retrieve-execute type of PM task (REPM)
   * one variable that seems to affect magnitude of age differences on PM task is demands of background task (BT); resource demands of BT can sig. affect PM, especially for older adults
   * age-related deficits in remembering to perform an action could be due to older adults having fewer resources available for the PM task and not to an inherent deficit in retrieving PMs
   * when retrieval cue is salient, an automatic retrieval process is stimulated that obligatorily delivers intended action to consciousness
   * unclear what to expect when one has to delay execution of intention after retrieval (retrieve-delay PM task / RDPM)
   * purpose of present research to examine RDPM performance
   * reasonable to propose that reformulating a plan while performing an ongoing task and strategically maintaining an intention would be heavily dependent on working-memory resources
   * consistent evidence that increasing working-memory demands of BT decreases PM performance, especially for older adults; relation b/w WM and PM - very little evidence for an association between the two;

   * experiment 1: created a delay of 30-39s b/w occurrence of PM target and when it was appropriate to perform intended action; also measured WM capacity; varied presence or absence of secondary digit-detection task;
   * highly salient targets used; given possible similarities and differences b/w REPM and RDPM, we could anticipate absence or presence of age-related deficits
   * to equate conditions, needed to present the older adults with less material and at a slower rate;
   * design was 2 (age) x 2 (delay/no delay) x 2 (attentional demands, WS); reading 3-sentence paragraphs, followed by reading-comprehension questions, two trivia questions; had interest in ability to remember to perform future actions; if they encountered a target word on any of the 3 sentences, they were to immediately press the F1 key (REPM), or to delay until the trivia phase (RDPM); those in divided attention condition given digit-monitoring task, see [Einstein 97]; 
   * 20 paragraphs presented either w/ or w/o digit monitoring task, counterbalanced in each exp. condition, first prospective target appeared in 3rd paragraph, PM targets not presented in consecutive paragraphs; target words always appeared in 2nd sentence of a paragraphs; following this, subjects given vocab. test and WM memory span test;
   * results: introducing a delay significantly lowered PM performance in no-delay and delay conditions; in no-delay condition, main effect of age was marginally significant; PM performance not affected by divided attention, no interaction b/w age and divided attention; highly salient target -> near perfect performance in no-delay condition regardless of age and divided attention; 
   * in delay condition, main effect of age: younger participants had higher PM than older participants, PM performance sig. worse in divide attention, decrement more pronounced for older adults (but no interaction); highly salient targets for REPM to not depend on availability of attentional resources, RDPM tasks poses special difficulties for older adults; 
   * smaller working memory spans for older adults; WM resources related to maintaining a PM intention over delay interval; WM likely a major factor in mediating relation b/w age and PM; analyses suggest age-related effect in PM primarily associated w/ WM processes; 
   * other measures: dividing attention interfered w/ comprehension, younger adults had higher scores than older adults, older adults more difficulty w/ digit monitoring

   * experiment 2: important purpose of second experiment was to examine reliability of this rapid loss of PM and age-related differences after a delay; under these conditions, maintaining intended action in working memory after retrieval would be more critical for successful PM;
   * varied demands of delay activity and length of delay (10, 30s) - delays were filled/unfilled w/ synonym questions; 
   * older adults do not have working memory resources needed to actively maintain intention through rehearsal over retention interval while simultaneously performing BT; performance  on RDPM should be affected by demands of BT, during unfilled delays all participants should be affected by demands of the activities occurring during the delay; during unfilled delays all participants should be able to focus their WM resources on task of maintaining intention, performance should be high for older adults and younger adults;
   * [Hasher and Zack 88,94]: ageing disrupts efficient functioning of inhibitory processes, perhaps more distractible, difficulty inhibiting thoughts unrelated to the cognitive demands of maintaining an intention until it is performed; older adults may show large amounts of forgetting even with unfilled delays;
   * pilot work indicated that older adults had great difficulty reading items, generating answers, circling answer within allotted time; called out answers instead to experimenter
   * 2 (young/old) x 2 (delay, WS) x 2 (filled/unfilled delay, WS) mixed factorial design; delay was synonym task or break for 10 or 30 s; target always occurred in last sentence of paragraph, thus delays b/w offset of sentence containing target and occurrence of target phase were wither 10 or 30s; each participant received 5 short-unfilled, 5 short-filled, 5 long-unfilled, and 5 long-filled delay periods, 4 counterbalanced orderings, equal # of participants assigned to each delay order;
   * given WM operation span test afterwards to establish more general support for relation b/w WM and performance on RDPM tasks;
   * 2 x 2 x 2 mixed ANOVA - not a reliable effect of length of delay (surprising); nor of activity during the delay; interaction between age and activity during delay was reliable - filled delays negatively effected PM for younger subjects, slightly increased PM for older adults (not reliable); having a break vs. filled interval didn't make a difference for older adults; results not consistent with view that age-related decrements on RDPM task are due to inability of older adults to actively maintain intention in WM until appropriate time;
   * reduced inhibition of distracting thoughts produces difficulties in remembering the retrieved attention
   * WM results: younger had sig. higher operation span than older adults;
   * hierarchical regression analysis to determine the extent to which the relation b/w age and PM performance could be understood in terms of WM ability; age-related decline in PM remained significant; interesting to note that the one condition in which the relation b/w age and PM was no longer stat. sig. was the condition that paralleled the conditions in Exp. 1. (filled, long delay); for shorter intervals and for unfilled intervals, age-associated factors other than working memory also play a sig. role in RD tasks
   * other measures: younger answered more comprehension q's correctly than older

   * experiment 3: explore generality of older adults' rapid loss of PM after a brief delay; the sense that task is easy (salient target) could encourage them to forego effortful strategies for maintaining intention in WM throughout the delay; robust drop in performance from immediate to delayed execution for older adults should be eliminated for PM cues that do not support fairly effortless retrieval of the PM intention;
   * method: 2 (target-action interval - delay/no-delay) x 2 (attentional demands (standard, divided) mixed factorial design, non-salient targets;
   * sig. decline in PM under divided attention condition relative to standard attention condition; effect in delay and no-delay groups; more difficult than high-salient cue conditions in Exp. 1, as divided attention did not disrupt PM in no-delay condition in Exp. 1; result of importance: no decline in PM performance when there was a short delay b/w low-salient cue and instant at which the PM tasks was to be performed;
   * retrieval of the PM intention not related to WM capacity; correlations for delayed cells failed to show associations b/w PM memory and WM; in response to difficult initial retrieval, participants may adopt a more strategic approach to maintaining the intention over the delay interval; 60% of participants remembered on some but not all trials;

   * discussion: substantial increase in PM forgetting when execution of intention had to be briefly delayed after initial retrieval of intention; decline in PM after brief delay was especially pronounced for older adults, even at short (10s) unfilled delays; no memory loss in Exp. 3 with non-salient target event;
   * maintaining an intention over a brief interval is highly susceptible to forgetting difficulty of maintaining an intention over brief delay is sig. amplified for older adults;
   * older adults do not have the WM capacity to actively maintain intention over delay interval while performing BTs; declines for older adults were substantial regardless of whether or not the interval was filled, and declines tended to be somewhat more pronounced with shorter 10s intervals than for the longer 30s intervals;
   * on the basis of the strength of this memory at the moment of retrieval older adults may be deceived into assuming that controlled processes (rehearsal) are unnecessary, successful maintenance over delays as brief as 10s would require strategic rehearsal; older adults are less likely to initiate strategic rehearsal of the intention because they are unaware of the temporal limits of WM for passive storage of information; 
   * older adults are thought to have greater difficulty binding features of an event to the spatial and temporal context in which that event occurs, older adults may have fewer spontaneous overt reminders of the PM task over the delay interval; filled delays with a greater similarity with the general contextual features of the PM task would produce more reminding and better PM memory;
   * frontal systems are though to maintain associations b/w environmental conditions and intended goals; with frontal decline, these associations are maintained in an deteriorated state, such that current goals are not as tightly connected w/ enabling conditions; salient cue of no greater negative effects of filled delays for older adults and of reliable correlations b/w WM measures and PM in retrieve-delay conditions; maintenance of intention is not strategic and instead dependent on ability of WM to maintain one's current goals in a sufficiently activated state; 
   * evidence that in naturalistic settings, people will reformulate their prospective plans in response to new environmental constraints;
   * although a large proportion of age-related variance in PM was associated w/ WM, there was also sig. age-related variance after controlling for WM; mechanisms that are not obviously related to WM capacity like differences in metamemory and inhibitory control are needed in addition to WM capacity for a complete understanding of age-related decrements in RDPM tasks;
   * when initial retrieval is difficult, older participants are more sensitive to challenge of maintaining intentions over brief intervals and ma¥ rely on controlled processes (rehearsal) to keep intention activated over the delay interval; possibility that the difficulty of maintaining an intention over a delay interval may be inversely related to difficulty of initial retrieval; 
   * easily maintained intentions may be very difficult to maintain over brief intervals;

---++++ [McDermott 04]

!McDermott K, Knight RG. The effects of aging on a measure of prospective remembering using naturalistic stimuli. Applied Cognitive Psychology. 2004;18(3):349-362. Available at: http://doi.wiley.com/10.1002/acp.977.

   * abstract: determine effect of age on noticing and memory search stages of a PM task; use of naturalistic stimuli; older participants had disproportionate reduction in recall of actions relative to cues notices compared to both younger and middle-aged participants; noticing complex and naturalistic visual cues in a shopping environment may rely primarily on automatic memory processes, whereas memory search depends on more strategic and conscious memory processes;

   * intro: aimed to construct a measure that would avoid the ceiling effects of many single-item tests of PR;
   * familiarity with naturalistic tasks mobilise a high degree of motivation in patients w/ brain injuries and older adults;
   * to enhance distracting nature of street scene, participants asked to keep count of number of strollers and bicycles; naturalistic equivalent of ongoing task used in laboratory measures of PM;
   * important distinction b/w automatic memory processes relevant to noticing stage and conscious and strategic processing involved in search stage; depending on characteristics of task, likely that noticing may involved both automatic and conscious search processes; evidence that automatic processing is relatively invariant with age, whereas capacity for conscious memory search declines;
   * in present study, unfamiliar environment used to minimise participants' opportunity to search actively for relevant cues; retrospective recall of associated action is assumed to require a self-initiated search process that is primarily conscious; possible that some actions are recalled automatically;
   * age-related decline in event-based PM has been demonstrated consistently
   * Rendell and Craik raised possibility that PM would be unaffected by age on tasks completed under real-life conditions; older participants' performance was superior to that of the younger group; although younger people generally have better PR skills, older people may show superior performance on naturalistic tasks where they are likely to be highly motivated to succeed and have sufficient time available to focus on remembering intentions

   * method: participants additionally required to report how many bicycles and strollers seen during video, make cell phone call to make doctor's appt 20 min after video started;
   * results: sig. main effect of age, sig. main effect of proportion (cues/response) correct, significant interaction; simple main effects of age with both proportion scores; proportions of cues and tasks remembered did not differ between younger and middle-aged group; older group differed from both other groups on proportion of tasks recalled; older adults had proportionally more difficulty correctly recalling the action to be taken than noticing visual cues for action than did other two groups;
   * consistent decline in performance on recalling cue and task for each item across age groups; regardless of nature of item, older individuals less likely to complete instructed action;
   * counting bicycles and strollers: group means did not differ significantly;
   * time-based recall: sig. group difference; older differed from younger, not from middle-aged;

   * discussion: participants disproportionately less able to perform memory search than to notice relevant cue compared to younger and middle-aged groups; recognising a cue but being unable to remember what it means becomes more common in old age; 
   * very little is known about affect of middle-age PM; performance of this group did not differ from younger group in any significant way; substantial decline in memory processes associated with strategic memory search for recall of actions is not likely to occur until later life; 
   * failure of older persons on time monitoring tests has been observed in previous studies;
   * number of instructions given to participants clearly outside range that anyone would normally attempt to complete in everyday life; previous research shown that recognising cues in environment is relatively easily accomplished;
   * one feature of PM task is that it necessitates an interruption to one's activity in order to carry out the intention; without such an ongoing task many PM tests in laboratory settings would be tests of vigilance and few failures of PM would occur; naturalistic delay periods typically filled with natural distractions and internal cognitions;
   * previous studies demonstrated age invariance w.r.t. automatic processes in presence of marked deterioration in controlled or strategic processing;
   * older persons took longer to notice cues; reduced efficiency in processing significance of instance of a cue; implicates self-initiated retrospective recall as most sig. reason for failure of PM among elderly;
   * test items not screened for age-specific content beforehand; differences in content of items are unlikely to have contributed substantially to PM decline among older people;
   * higher level processing may also have a role in decline of PM; age does not necessarily diminish ability to perform vigilance tasks, doing so may affect capacity of older participants to complete a concurrent PM task; this may be strategic decision based on their subjective estimation of likelihood of success on memory task or it may be that focusing on monitoring task diminishes attentional capacity to notice cues or recall intentions;

---++++ more...

   * !McDaniel MA, Einstein GO, Stout AC, Morgan Z. Aging and maintaining intentions over delays: do it or lose it. Psychology and aging. 2003;18(4):823-35. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14692867.

   * West R, Craik FI. Age-related decline in prospective memory: the roles of cue accessibility and cue sensitivity. Psychology and aging. 1999;14(2):264-72. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10403713.

   * Einstein GO, Smith RE, !McDaniel MA, Shaw P. Aging and prospective memory: the influence of increased task demands at encoding and retrieval. Psychology and aging. 1997;12(3):479-88. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9308095.

   * Morrow DG, Leirer VO, Altieri PA. Aging, expertise, and narrative processing. Psychology and aging. 1992;7(3):376-88. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1388858.

   * Plude DJ, Hoyer WJ. Age and the selectivity of visual information processing. Psychology and aging. 1986;1(1):4-10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/3267377.

   * Henry JD, !MacLeod MS, Phillips LH, Crawford JR. A meta-analytic review of prospective memory and aging. Psychology and aging. 2004;19(1):27-39. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15065929.

   * Carlson MC, Hasher L, Connelly SL, Zacks RT. Aging, distraction, and the benefits of predictable location. and Aging. 1995;10(3):427-436. Available at: http://www.psych.toronto.edu/users/hasher/PDF/Carlson et al 1995 Psych and Aging.pdf.

   * Park DC, Hertzog C, Kidder DP, Morrell RW, Mayhorn CB. Effect of age on event-based and time-based prospective memory. Psychology and aging. 1997;12(2):314-27. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9189992.

   * Maylor EA. Age-related impairment in an event-based prospective-memory task. Psychology and aging. 1996;11(1):74-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8726372.

   * Marsh RL, Hicks JL, Landau JD. An invesitgation of everyday prospective memory. Memory and Cognition. 1998;26:633â&#128;&#147;643. Available at: http://www.psychology.uga.edu/hcpl/pub_pdf/16.pdf.

   * Jennings J., Jacoby LL. An opposition procedure for detecting age-related deficits in recollection: telling effects of repetition. Psychology and aging. 1997;12(2):352-61. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9189995.

   * !McDaniel MA, Einstein GO. Strategic and automatic processes in prospective memory retrieval: a multiprocess framework. Applied Cognitive Psychology. 2000;14(7):S127-S144. Available at: http://doi.wiley.com/10.1002/acp.775.

   * Ellis J, Kvavilashvili L. Prospective memory in 2000: Past, present, and future directions. Applied Cognitive Psychology. 2000;14(7):S1-S9. Available at: http://doi.wiley.com/10.1002/acp.767.

   * Rendell RG, Craik FI. Virtual week and actual week: Age-related differences in prospective memory. Applied Cognitive Psychology. 2000;14(7):S43-S62. Available at: http://doi.wiley.com/10.1002/acp.770.

   * Alderman N, Burgess PW, Knight C, Henman C. Ecological validity of a simplified version of the multiple errands shopping test. Journal of the International Neuropsychological Society : JINS. 2003;9(1):31-44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12570356.

---

---+++ On cognitive reserve / brain training (!FuturePlay ref's)

---++++ more...

   * K. Ball, D.B. Bersch, K.F. Helmers, J.B. Jobe, M.D. Leveck, M. Marsiske, J.N. Morris, G.W. Rebok, D.M. Smith, S.L. Tennstedt, F.W. Unverzagt, and S.L. Willis, "Effect of cognitive training interventions with older adults," Journal of the American Medical Association, vol. 288, 2002, pp. 2271-2281.

   * A.M. Owen, A. Hampshire, J.A. Grahn, R. Stenton, S. Dajani, A.S. Burns, R.J. Howard, and C.G. Ballard, "Putting brain training to the test," Nature, 2010, pp. 1-5.

---

---++ Clinical Conditions and Diagnoses

---+++ Review Papers

---++++ [Feldman 05]

H.H. Feldman and C. Jacova, "Mild Cognitive Impairment," American Journal of Geriatric Psychiatry, vol. 13, 2005, pp. 645-655.

   * MCI - cog. func. below normal levels, yet not dementia;
   * subtypes - AAMI (age-assoc. memory imp.), AACD (age-assoc. cog. decline), MCIa (amnestic MCI), CIND (cog. impair not dementia)
   * etiological (def): the cause, set of causes, or manner of causation of a disease or condition; the causation of diseases and disorders as a subject of investigation.
   * is MCI prelude to dementia; what is earliest stage of definable dementia; are there benign forms of MCI?
   * nosology (def): the branch of medical science dealing with the classification of diseases.
   * AAMI - defined psychometrically by scores on mem. tests 1SD below norms; other cog. func. unimpaired; not caused by specific neurological, psychiatric, medical cond.; most overlap w/ normal ageing.
   * AACD - cog. effects of ageing beyond mem. domain - learning, memory, attention, thinking, language, visuospatial func.; onset over at least 6 mo. w/ requisite for confirmatory collateral history from reliable informant; 1SD below norms on tests of one of these cog. domains; insufficient to meet diagnostic criteria for dementia, not accounted for by systemic, neurological, psychiatric disorders;
   * MCIa - memory complaints, generally 1.5SD below norms on psychometric tests; cog func. otherwise normal with ADL: activities of daily living; clinical dementia rating of 0.5; possible extension alteration to MCI multiple-domain and MCI single non-memory domain
   * CIND - no consensus to date on operational definitions of the condition and whether there should be specified psychometric norms applied
   * MCI (criteria) - neither demented nor normal - report of cog. decline supported by impairment on objective cog. tasks, evidence of decline over time; syndrome associated within a widely heterogenous group of diseases / disorders, from medical to neurological to psychiatric - assessed etiologically, promote appropriate medical mgmt;
   * prevalence rates: higher in referral-based samples likely because of spectrum bias - indvls presenting to dementia clinic are more likely to have AD (alzheimer's) at the MCI stage than indvls in primary care or volunteer community settings; suggestion that AACD captures a broader range of cog. impairments;
      * avg. 10% annual rate of progression from MCI to dementia - varied considerably across MCI subtypes and settings; rates of progression from AACI to dementia are reported to be lower than AACD to dementia;
      * rates of reversion or recovery to normal from MCI differs for subtypes and settings - evidence is accruing on incidence rates within these subtypes as well as on their different dementia outcomes;
   * screening: early MCI recognition can allow necessary diagnostic work-up to be undertaken, reversible etiologies and risk factors to be treated, counselling to be provided, therapy to be initiated; need to develop valid screening tools that can discriminate between normal and MCI and identify MCI individuals most likely to progress to dementia; no widely accepted screening tests for MCI;
      * MMSE - mini-mental state exam
      * Neurotrax mindstreams - computerised test
      * diagnostically validated tests likely to have utility in general practise because they are capable to detecting MCI, alerting the practitioner to seek and treat reversible etiologies, guiding the need for specific referral;
   * study designs in which diagnoses have been made clinically and independently of psychometric tests have more validity than studies in which the psychometric tests were part of the diagnostic algorithm;
      * studies have consistently identified episodic memory deficits as being predictive of later progression to dementia; semantic memory/language deficits are predictive of dementia; highest risk of dementia still belongs to group with disproportionate memory impairment; episodic memory impairment is feature of abnormal, clinically relevant, cognitive functioning that may herald the onset of dementia
      * reliability of clinical judgment must still be demonstrated, w/ consideration to speciality and expertise of the clinician
   * neuroimaging: extent to which the neuroimaging findings from these highly selective studies generalise to MCI population that presented to dementia clinics and general practice is unknown; further studies: determine diagnostic usefulness of MRI and PET in real-world patients.
   * prevention: no successful pharmacological interventions to slow/reduce incident rates of MCI from normal;
   * caveats: predictive validity around various definitions of MCI that are in use have not been fully determined; generalizability of findings from highly specified samples to general MCI population will require additional study;

---++++ [Feldman 08]

H.H. Feldman, C. Jacova, A. Robillard, A. Gracia, T. Chow, M. Borrie, H.M. Schipper, M. Blair, A. Kertesz, and H. Chertkow, "Diagnosis and treatment of dementia: 2. Diagnosis," Canadian Medical Association Journal, vol. 178, 2008, pp. 825-836.

   * abstract: dementia can now be accurately diagnosed through clinical evaluation, cog. screening, laboratory eval, structural imaging; 32 recommendations related to diagnosis of dementia; insufficient evidence to recommend routine functional imaging, measurement of biomarkers, neuropsychological testing
   * cog. impairment and dementia present in about 20% of elderly population and are consistently rated among top 3 concerns of elderly people;
   * better cog. screening tools and more specific/expensive means of diagnosing Alzheimer's disease
   * approach to diagnosis: clinical diagnosis, logical search for cause, identification of treatable comorbid (def: the simultaneous presence of two chronic diseases or conditions in a patient)conditions and other contributing factors, such as degree of cerebrovascular disease;
   * diagnostic in 6 steps: patient history, interviewing caregiver/family, phys. exam, brief cog. tests, laboratory tests, structural imaging for patients meeting certain criteria; last 3 usually restricted to specialist practice
   * recommendations for diagnosis of dementia:
      * range of brief cog. tests for discriminating between dementia and normal state - insufficient evidence to recommend one test over the others; not developed to differentiate between dementia subtypes;
      * diagnosis of dementia remains clinical - must retain diagnostic criteria currently in use, continued use of NINCDS-ADRDA criteria (Alzheimer's); mild Alzheimer's can be diagnosed with a high degree of specificity;
      * genetic testing;
      * neuropsychological testing - distinction between normal ageing, mild cog. impairment, or cog. impairment without dementia, early dementia; risk of progression from mild impairment or cognitive impairment without dementia to dementia or Alzheimer disease; differential diagnosis of dementia and other syndromes of cog. impairment;
   * clinical eval - brief cog. tests - serve to determine presence of overall severity of memory and cognitive deficits and can be recommended for both primary care and specialty practice;
      * MMSE remains most widely used; score of 18-26 of 30 = mild dementia, 10-18 = moderate dementia, less than 10 = severe dementia - focuses on memory, attention, construction, orientation; Modified MMSE includes delayed recall
      * clock-drawing also used - may lack sensitivity for the diagnosis of early or mild dementia;
      * newer tests have been shown to be more accurate than the MMSE in discriminating between dementia and normal cognition, particularly in cases of mild dementia
         * coverage makes these tests more accurate in detecting dementia in heterogeneous populations
         * lack clear knowledge of advantages of one test over the others; recommends routine use;
      * some without dementia can score low on MMSE, w/ dementia < 20; dementia is even possible with scores > 26; language barriers, advanced age, low education can confound results and provide false positives
      * no brief cog/ test can differentiate betwen subtypes of dementia
   * important to exclude delirium - condition that is transient, reversible, acute confusional state 
   * diagnostic criteria for dementia - acquired impairment in memory, associated with impairment in one or more of cog. domains: executive thinking, language, praxis, gnosis; impairments in cognition must be severe enough to interfere with work, usual social activities, relationships with others;
   * neuropsychological testing routinely requires 2-4 hrs of patient's time, costs between 600$ and 1500$, not covered by prov. health plans; w/ expert interpretation it has shown utility in distinguishing early or mild dementia from mild cog. impairment or cog. impairment without dementia and from normal cog. function; contribute to determining likelihood of future dementia in at-risk groups, utility in distinguishing between dementia subtypes; considerable specificity, far greater than brief cog. testing; expensive, not ready in family practices;
   * knowledge gaps: clinical definitions have a historical basis rather than empirical one; lack proof that the definition of dementia is superior to alternative ones, or the definition of cog. domains is optimal;
   * hurdles to diagnosing dementia: physicians lack of familiarity  w/ cog. screening; complexity of diagnosing process, pressures of time, lack of general conviction that an accurate diagnosis of dementia warrants the requisite effort;
   * non-Alzheimer dementias: frontotemporal dementia - prominent behavioural changes and language impairment; dementia associated w/ Lewy bodies or Parkinson's - neuropsychiatric features includes visual hallucinations and fluctuations in disease course; vascular dementia - stepwise fashion, dysexecutive syndrome, focal neurological findings;

---++++ [Dubois 07]

B. Dubois, H.H. Feldman, C. Jacova, S.T. !DeKosky, P. Barberger-Gateau, J. Cummings, A. Delacourte, D. Galasko, S. Gauthier, and G. Jicha, "Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDSâ&#128;&#147;ADRDA criteria," The Lancet Neurology, vol. 6, 2007, pp. 734-746.

   * abstract:
      * new techniques prevailing: distinctive and reliable biomarkers of AD; structural MRI; molecular neuroimaging with PET; cerebrospinal fluid analysis;
      * framework to capture both earliest stages, before full-blown dementia; new criteria centred on clinical core of early and significant episodic memory impairment
      * validation studies needed to advance these criteria and optimise their sensitivity, specificity, accuracy;
   * criteria of DSM-IV-TR: statistical manual of mental disorders, 4.ed, NINCDS-ADRDA;
   * prodromal (def.): relating to or denoting the period between the appearance of initial symptoms and the full development of a rash or fever.
   * specification that onset of AD is insidious and there is lack of other systemic or brain diseases that may account for the progressive memory and other cog. deficits; more refined definition of AD is still needed to reliably identify the disease at its earliest stages;
   * distinction between MCI (mild cog. impairment, amnestic mild cognitive impairment, preclinical AD: long asymptomatic period between first brain lesions and first appearance of symptoms, prodromal AD: symptomatic predementia phase of AD (generally MCI), AD dementia;
   * improved recognition of non-AD dementia - operational definition and characterisation of non-AD dementia has improved; criteria developed that aim for high specificity; progress of clinical defn. of non-AD dementia improves sensitivity of currently accepted diagnostic criteria for AD by reducing level of uncertainty; improved defn. of AD phenotype, need to test early intervention;
   * problems w. defn. of MCI: potential usefulness for clinical trials directed at delaying time to onset of AD - to address recognised clinical and pathological heterogeneity, subtyping MCI may be useful; 70% of those w. MCIa progressed to dementia actually met neuropathological AD; most accurate determination that indvl. had prodromal AD is critical; 
   * special care will be needed to limit toxic therapies to those w/ prodromal AD and those destined to develop non-AD dementia;
   * revised criteria to eliminate MCI construct, bypassing binary outcome in clinical categorisation process associated with it as well as problems w/ reliability;
   * objective: developing a diagnostic framework for AD that would include prodromal stages and integration of biomarkers and to validate framework
   * core diagnostic criterion - early episodic memory impairment:
      * gradual and progressive change in mem. function at disease onset reported by patients/informants for period > 6 mo.
      * objective evidence of sig. impaired episodic mem. on testing
      * ep. mem. impairment can be isolated or associated w/ other cog. changes at onset of AD - exec. function (abstract thinking, working memory, mental set, language (naming, comprehension), praxis (imitation, production, gesture recog.), gnosis (recog. of objects/faces)
   * core diagnostic criteria for AD: three above criterion + one or more supportive features: medial temporal lobe atrophy, abnormal cerebrospinal fluid biomarker, specific metabolic pattern on functional neuroimaging w/ PET, proven AD autosomal dominant mutation w/in immediate family
      * exclusion criteria: sudden onset, focal neurological findings, sensory loss, other clinical / medical disorders (i.e. major depression), delusions, apathy; - seizures, gait disturbances, extrapyramidal signs: relating to or denoting nerves concerned with motor activity that descend from the cortex to the spine and are not part of the pyramidal system, fluctuations in REM sleep, cerebrovascular disease, Lewy bodies, presence of delirium, toxic metabolic cause (altered state of consciousness)
      * evidence of early and previous episodic memory deficit as mandatory req. for AD diagnosis
      * criteria for definite AD: both clinical and histopathological evidence, both clinical and genetic evidence
   * ep. mem testing: delayed recall suffers worse than immediate recall; genuine deficits in encoding and storage that are characteristic for AD must be distinguished from non-AD deficits that can also affect delayed recall, incl. attentional difficulties that may be present in depression, inefficient retrieval strategies assoc. w/ ageing, frontotemporal dementia, subcortical-frontal dementias;
   * measures of sensitivity to semantic cueing can successfully differentiate patients w/ AD from healthy controls, even when patients are equated to controls on MMSI scores or when disease severity is very mild;
   * patients w/ very mild AD also have a measurable reduction in sensitivity to cueing, reliably identifies prodromal AD;
   * neurobiological imperative to identify AD before the point of disease where irreversible pathological injury would prevent effective intervention, proposed criteria should allow an earlier and more specific AD diagnosis; 
   * more balanced approach because clinical phenotype of AD is better known than its biological phenotype; time for assigning different weightings to its supportive features or recommending combinations of features, or alternatively requiring presence of all; other combinations may prove to have greater diagnostic accuracy or new features may be introduced; 
   * criteria represent a cultural shift req. more biologically focused work-up than prev. approaches;
   * if non-AD is suspected, must be ruled out carefully on case-by-case basis by applying in parallel the diagnostic criteria for the other disorders;
   * criteria still require decisions around how they are to be put into practice; not yet defined a magnitude of deficit or the comparative norms that should be used; no specification of the amount of atrophy that is optimally diagnostic of AD; foresee that technically less demanding criteria for clinical settings might develop from the more technically challenging research criteria once these are validated;

---++++ more...

   * J.E. Graham, K. Rockwood, B.L. Beattie, R. Eastwood, S. Gauthier, H. Tuokko, and I. Mcdowell, "Prevalence and severity of cognitive impairment with and without dementia in an elderly population.," Lancet, vol. 349, 1997, pp. 1793-6.

   * H. van Rijn, J. van Hoof, and P.J. Stappers, "Designing leisure products for people with dementia: developing ''the Chitchatters'' game.," American journal of Alzheimer's disease and other dementias, vol. 25, 2010, pp. 74-89.
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