GIANLUCA DE LEO PhD MBA

C O L L E G E O F H E A L T H S C I E N C E S

V I R G I N I A M O D E L I N G A N A L Y S I S A N D S I M U L A T I O N C E N T E R

O L D D O M I N I O N U N I V E R S I T Y

N O R F O L K V A , U S A

G D E L E O @ O D U . E D U

+ 1 7 5 7 6 8 3 6 7 3 3

SHORT-TERM MEMORY LOSS AND SMARTPHONE APPS

Outline

Who am I?Smartphone: a

disruptive technology

Brief overview of Alzheimer's disease

Smartphone solution to capture daily life moments

Case study research project

Results

Vision Q&A

Who am I?

In St. Louis, MO:

• PhD, Biomedical Engineering (2003)

• Post Doctorate, Public Health Informatics (2005)

• MBA (2005)

In Genova, Italy:

• BS, Electronic Engineering (1997)

• MS, Electronic Engineering (1999)

Who am I?

Question

How many of you have heard about:

disruptive technology?

Disruptive technology

A disruptive technology or disruptive

innovation is an innovation that helps create a

new market and value network, and eventually goes

on to disrupt an existing market and value network

(over a few years or decades), displacing an earlier

technology there. [1]

Disruptive technology

Horse-drawn vehicles Early cars

Do you think that "early cars" should be considered

disruptive technology?

Disruptive technology

Horse-drawn vehicles FORD Model T

FORD Model T was a disruptive technology!

Disruptive technology

Cable-operated excavator

Hydraulic excavator

The hydraulic excavator was a disruptive technology!

Smartphones (1999)

• NOT yet a disruptive

technology

• NOT affordable

• NOT easy to use

Smartphones: Disruptive technology (2011)

Smartphones:

• disruptive technology• affordable• easy to use• changing how we:

• Communicate• Interact• Play/access music• Take pictures• Access information

My experience with smartphones

I Click I Talk:

The research driven AAC system for iPhone, iPadand Windows.

Perfect for all ages, all

communication disabilities

and all languages.

Background on Alzheimer's

Significance• Currently, 5.4 million Americans are affected with

Alzheimer's Dementia [2]

Science

• Alzheimer's is a neurodegenerative disease causing progressive decline in memory.

• The disease’s most frequent and recognizable symptom is memory loss associated with recent events [2]

Stages and Effects

• Three main stages: Mild, Moderate and Severe. • Patients suffer from increasing confusion,

disorganized thinking, impaired judgment, trouble in expressing themselves, and disorientation.

• Dependence on caregivers increases steadily to the point of becoming burden, affecting the quality of life of patients and caregivers [2]

Treatment• No permanent solution, but cuing patients about the

past events can reduce the rate of decline in memory [2]

Background on Alzheimer's

The capacity to remember recent events is linked to autobiographical memory, human memory responsible for archiving and recollection of specific personal experiences [3]

Autobiographical memory allows people to have a coherent tale of their personal experiences [4], a sense of self [5], and a ‘‘life history’’ to talk about with other people [6]

Loss of autobiographical memory causes confusion and frustration in patients with AD, and their caregivers have to step in to assist in the memory recall process

SenseCam

The SenseCam is a wearable digital camera that is designed to take photographs while it is being worn, without any user interaction

This specialized camera captures a picture every 30 seconds. These pictures are uploaded to a computer by a nurse and combined into a movie. The movie is then shown to the subject. The movie serves as a recap of the subject’s day

http://research.microsoft.com/en-us/umcambridge/projects/sensecam/introduction.htm

Now a product byVicon Motion Systems Inc http://viconrevue.com$500

My personal experience with Alzheimer's

My grandmother (on my mother’s side)

1917 – 2008

• Healthy individual• Her memory (recent events)

started declining in 1990• Degenerated to no

communication in 2006• Increase burden on caregivers

(her 3 daughters)

Smartphone

• Samsung Blackjack

Flat surface less blurred images

Windows based

• iPhone does not allow taking picture automatically

Test idea: the smartphone was programmed to capture an image every 5 minutes by using the in-built camera

Daily life moments

Daily life moments

Research opportunity (2008)

Smartphone solution to capture daily life moments

The subject/caregiver uses a pre-stamped envelope to return the completed test and survey to the investigator

DVDs containing the final slideshows are mailed to the patient every week along with a satisfaction survey and a memory recall test

The images are automatically retrieved, date-stamped, combined into a slideshow, and burned onto a DVD

The subject carries the smartphone during the day, by way of the supplied lanyard, for 4 weeks The smart phone automatically takes pictures every 5 minutes during the day (8:00 a.m. to

8:00 p.m.) and uploads them to a secure server during the night (at 2:00 a.m.)

Subject

Patient at the Hampton Roads Neurophysiology Clinic,

located in Virginia Beach, Virginia

80-year-old, right-handed, married male in stage 4 of

the FAST scale (Mild

Alzheimer’s) [7]

Holds a master’s

degree and is a retired military officer

Familiar with the use of cell

phones

His caregiver was his wife, age 73, also a

college graduate. They had

been married for 54 years

Measurements

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

(before and after the interventions) [8]

Subject Satisfaction Survey

(once a week)

Recent events memory recall test

(once a week)

Methods

Subject Satisfaction Survey (once a week, Likert scale 1 to 5)

I feel comfortable wearing the smart phone around my neck

The smart phone is invasive

Seeing images from the slideshow brings back the memories of recent events

I feel less anxious knowing that the smart phone is recording what I am doing

I feel more relaxed in social situations because the slideshow will show me who I meet

Sharing past experiences through the slideshow with my family is a pleasure

Watching the slideshow helps me deal with daily tasks better

Recalling events with the help of the slideshow agitates me

Watching the slideshow with my family is boring

The slideshow has been a useful tool for my family

The slideshow has been a useful memory aid for me

The smart phone is easy to use

Methods

Recent events memory recall test (once a week, yes or no)

Results

Results

Subject Satisfaction Survey

The subject did not have any problem wearing the device

The subject considered the slideshow a useful tool for helping to live with persistent memory loss.

Results

It is possible to capture one's real life experiences without any involvement of the subjects.

Pictures collected do represent an ensemble of the important events occurred in the past.

Pictures from smart phones may indeed be used as an assistive device in the recall of recent events.

Limitations/problems

Case study with only one subject

Battery did not last the entire day

Subject forgot to wear the device (one day)

Smartcard was accidently disconnected (no pictures for a week)

Caregivers involvement is needed

Vision

No more DVD. Images will be made available on the web and subjects will look at them using tablets

Surveys available on-line

GPS capability

The smart phone (camera, data connection, and operating system) will be miniaturized and made available in the form of jewelry or a tie pin

Vision

EMERGENCYCARE

HOSPITALCARE

ACUTEPATIENTS

CHRONICPATIENTS

TRADITIONALBIOMEDICAL

MARKET SEGMENTS

PRIMARYCARE

CITIZEN

PREVENTIVECARE

EMERGING MARKET SEGMENTS

WELLNESS

CONSUMER NEXT GENERATION MARKET SEGMENTS

Research partners

Eleonora Brivio, MS

Old Dominion University

Scott W. Sautter, PhD, FACPN

Hampton Roads Neuropsychology

Virginia Beach VA

Project funded by:

The Virginia Center on Aging, Virginia Commonwealth University, Richmond, VA (2008)

References

[1] Bower, Joseph L. & Christensen, Clayton M. (1995). "Disruptive Technologies: Catching the Wave" Harvard Business Review, January–February 1995[2] Alzheimer’s Association. (2011). 2011 Alzheimer’s disease facts and figures. Retrieved from http://www.alz.org/downloads/Facts_Figures_2011.pdf[3] Lee, M. L., & Dey, A. K. (2007). Providing good memory cues for people with episodic memory impairment. In Proceedings of the 9th International ACM SIG ACCESS Conference on Computers and Accessibility (pp. 131–138). New York, NY: ACM. [4] Barclay, C. R. (1986). Schematization of autobiographical memory. In D. C. Rubin (Ed.), Autobiographical memory (pp. 82–89). Cambridge, England: Cambridge University Press. [5] Brewer, W. F. (1986). What is autobiographical memory? In D. C. Rubin (Ed.), Autobiographical memory (pp. 25–49). Cambridge, England: Cambridge University Press. [6] Harley, K., & Reese, E. (1999). Origins of autobiographical memory. Developmental Psychology, 35, 1338–1348[7] Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: Reliability, validity, and ordinality. International Psychogeriatrics, 4(3), 55–69[8] Randolph, C. (1998). Repeatable Battery for the Assessment of Neuro- psychological Status (RBANS). San Antonio, TX: The Psychologi- cal Corporation.

References (who am I?)

[1] De Leo G, Ponder M, Molet T, Fato M, Thalmann D, Thalmann N, Bermano F, Beltrame F. A Virtual Reality System for the Training of Volunteers Involved in Health Emergency Situations. CyberPsycology & Behaviour, 2003; 6(3): 267-274.[2] De Leo G, Krishna S, Boren S, Fato M, Porro I, Balas E A. Web and Computer Telephone-Based Diabetes Education: Lessons Learnt from the Development and Use of a Call Center. J Med Syst , 2005; 29(4):343-355.[3] Boren SA, De Leo G, Chanetsa FF, Donaldson JF, Krishna S, Balas EA. Evaluation of a Diabetes Education Call Center Intervention. Telemedicine Journal and E-Health. 2006; 12(4):457-465.[4] Kott K, Lesher K, De Leo G. Combining a Virtual Reality System with Treadmill Training for Children with Cerebral Palsy. Journal of CyberTherapy & Rehabilitation. 2009; 2(1): 35-42.[5] De Leo G, Gonzales C, Battagiri P, Leroy G. A Smart-Phone Application and a Companion Website for the Improvement of the Communication Skills of Children with Autism: Clinical Rationale, Technical Development and Preliminary Results, J Med Syst. 2011; 35:703-711.

Any questions?

Thank you

for your attention