Workpackage 6: Technology for Maintaining Good Mental and Cognitive Health

Core ResearchCatalyst ProgramStrategic Investment Program
ICT applications for Screening, Assessment and Interventions to Enhance Mental Health – Workpackage 6.1 MEN-ASSESS

This project focuses on applications of information communication technologies (ICTs) for screening, assessment and interventions to enhance mental health among older adults. Products include customizable ambient activity technologies to reduce anxiety and challenging behaviours, a driving simulator to provide interesting experiences, a model for managing wandering risk, and a quality rating scale for mental health apps. 

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 780,730

Total Non-NCE Contribution: $ 195,873

Project Leads
  • Mark Chignell, University of Toronto
  • Lili Liu, University of Waterloo
Automated Assessments of Cognitive Impairment using Environment-based Sensing – Workpackage 6.2 COG-ASSESS

This project is developing a variety of hardware-software platforms to monitor a person’s daily-life activities in order to recognize changes that may predict future physical or cognitive decline. Furthermore, the project is developing products that encourage physical and cognitive activity and wellness. 

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 574,672

Total Non-NCE Contribution: $ 359,939

Project Leads
  • Eleni Stroulia, University of Alberta
Improving Pain care for Older Adults through the Use of Advanced Technologies – Workpackage 6.3 PAIN CARE

This team is developing innovative and affordable solutions to improve pain management in people with dementia who reside in long-term care facilities. This includes work toward an affordable and unobtrusive automated system that uses facial recognition technology and AI to monitor pain in people with severe dementia, app development/evaluation to facilitate assessments conducted by nursing staff, web-based training in cutting edge pain assessment for staff of rural and remote long-term care facilities and knowledge mobilization efforts using social media. 

Award Term: April 1, 2015 - March 31, 2020

AGE-WELL NCE Investment: $ 560,070 

Total Non-NCE Contribution: $ 570,589

Project Leads
  • Thomas Hadjistavropoulos, University of Regina
  • Babak Taati, Toronto Rehab Institute, The KITE Research Institute at University Health Network
Assessing Cognitive Ability using Automated Assessment of Speech – Workpackage 6.5-CAT

Clinical measures of cognition typically rely on time-consuming, subjective and expensive assessments. However, our recent advances in computational linguistics, signal processing, and machine learning now allow for objective, automatic, and rapid analysis of cognition, through speech. Our prior work has focused on binary classification problems between people with or without a particular disorder, such as Alzheimer’s disease. In this grant, we will use these modern tools to objectively assess cognition, differentially in people with post-stroke aphasia and memory impairment, by measures of speech and language at 5 time points. This will be applied to a new technological medium – the telephone, which will allow for broader data collection and unique insights in human-computer interaction.

Dr. Frank Rudzicz leads this project, with two industrial partners: WinterLight Labs, and CBI Health Group. WinterLight Labs will supply speech-based assessment to support data collection and data analysis. Patients will be recruited at CBI Health Group clinics, and clinical assessment will be provided by Drs. Regina Jokel and Andrea Iaboni. Research will be conducted at the Toronto Rehabilitation Institute, the Rotman Research Institute at Baycrest, and the University of Toronto.

Our primary objective is to validate the computational speech-based assessment techniques relative to current gold standard assessments. This will involve modern machine learning that is more incisive than the current state-of-the-art. This will be accomplished within two elicitation platforms: a traditional web-based interface, and a phone-based interface. Optimizing the latter is crucial in order to establish the feasibility of using this platform across as wide a population as possible.

In the short term, this project will 1) validate current automatic cognitive assessments, 2) create a new industrial collaboration between a large healthcare network and a local technology startup in Canada, and 3) further our understanding of cognitive function in different patient populations among older Canadians.

Project Leads
  • Frank Rudzicz, Toronto Rehab Institute, University Health Network
ALADIN: Adaptive Lighting for Alzheimer and Dementia Intervention – Workpackage 6.10-CAT ALADIN

This project will produce a smart light system to improve the sleep quality of dementia patients. Disruption of circadian cycles in Alzheimer’s disease and related dementias (ADRD) patients worsens in time. This leads to sleep problems, nocturnal wandering, and daytime irritability and manifests in a set of neuropsychiatric symptoms such as confusion, disorientation, anxiety, agitation, aggression, wandering and yelling. These increase the burden on caregivers both at homes and in institutional facilities. More than half a million people in Canada are diagnosed with dementia and we spend $10.4 billion annually for caring.

Typical lights at homes and care facilities are static and not tuned to activate the circadian cycles of older adults. We propose to develop Adaptive Lighting for Alzheimer and Dementia INtervention (ALADIN), a versatile light that addresses the lighting requirements for older adults. ALADIN is a wake-up lamp that doubles up as a daytime ambient lighting. This light will be auto colour temperature tuning, aligned with the sunlight pattern. This project will eliminate the existing multiple light sources that are manually adjusted throughout the day and provide a simplified design of a single lighting device, programmed to deliver the right type and level of light in time. Our team of technologists, clinicians and caregivers will work closely to ensure that the light addresses the needs of ADRD patients and is easily operable by them.

While the LED technology is very mature to create dynamic lighting, several questions related to user-centric design such as perception of light by aging adults, physiological effects, user control of lights, etc., will be addressed through the feedback of users. Successful development of lights will immediately help clinical researchers to embark on much needed, well-controlled long-term studies to target the ideal lights for dementia patients.

Project Leads
  • M. Cynthia Goh, University of Toronto
  • Venkat Venkataramanan, University of Toronto
Cycled lighting in the senior home: Effect on rest-activity, sleep, performance and psychological well-being – Workpackage 6.11-CAT

Sleep in the nursing home environment has been shown to be extremely disturbed and fragmented, in part as a result of decreased light exposure. Insufficient and/or mistimed artificial lighting can disrupt circadian rhythms, adversely affecting sleep, mood, and cognition. Elderly are more susceptible due to age-related changes in the circadian and ocular systems. In a collaboration between Simon Fraser University, the University of British Columbia, BC Hydro and Fraser Health Authority, we are examining the effects of tunable white lighting- changing in intensity (0-800 lux) and colour temperature (2700-6000K) over the 24-hour day in promoting circadian entrainment, performance and psychological well-being in older adults at the Nimi Nikkei Home, an assisted-living home in Burnaby, BC. Participants’ rest-activity cycle and sleep (tracked with actigraphy), cognitive performance (NIH toolbox) and psychological well-being (sleep quality, mood, and fatigue) will be compared in a within-subject-design consisting of two weeks of baseline (control condition with original lighting) and five weeks of experimental condition (cycled lighting), followed by three weeks of washout (control condition with original lighting).

Daily changes in the sun’s color temperature is an important signal through which the circadian system senses external time. Cycled lighting should therefore increase the effectiveness of indoor light as a circadian time cue, indicated by an increase in the amplitude of the rest-activity cycle, a gradual stabilization of sleep timing, a more normalized timing and duration, and less frequent awakenings. Also, we predict the cycled lighting to improve elderly participants’ cognitive performance and psychological well-being.

Product adaptation and verification of a technology to monitor cognition in older adults – Workpackage 6.8-SIP A1

Problem: According to the Alzheimer's Association, about 600,000 Canadians have some form of dementia, costing more than $10.4 billion annually. In 15 years, this number will climb to 937,000. Early diagnosis and ongoing validation of treatments with respect to cognitive impairment is critical to promote healthy aging amongst this population. Thus, there is increasing demand for rapid, user-friendly technologies to identify early decline in brain function. Yet, there are currently no cost-effective ways to monitor the physiological impacts of treatments for cognitive decline. Research suggests evoked potentials using electroencephalography (EEG), may provide such a measure. However, current state-of-the-art requires numerous 'leads' and extensive clinical training. Standard EEG testing puts strain on the cognitivelyimpaired, who have trouble sitting still for typical 1-hour examination periods: 25 minutes of EEG cap set-up and multiple paradigms each taking some 10 minutes. 

Purpose: We will validate the use of a low-cost, 'rapid output' EEG platform for the diagnosis and assessment of cognitive impairment. NeuroCatchTM is a clinician-friendly software tool, translating established brain waves into a clinicallyaccessible, understandable framework. NeuroCatchTM outperforms existing EEG tools by extracting critical brain data in about 5 minutes. NeuroCatchTM has been tested amongst people with brain injuries and concussions. Given that the cognitively-impaired have similar challenges, reworking the product for this population is a logical next step.

Impact: We will verify NeuroCatch's capacity to assess functional brain status amongst people with cognitive impairment, establishing a new product for healthy aging. Funding will support minor design changes, field-testing and deliver a validated prototype. Led by trainees, this project delivers a cheaper accessible tool for clinicians, saves healthcare costs, improves diagnosis and treatment monitoring and reaches the global cognition market, ultimately improving the lives of aging adults in Canada and internationally.

Project Leads
  • Frank Knoefel, Bruyère Research Institute
Technology-enhanced multimodal meditation for enhancing wellness in long term care – Workpackage 6.12-SIP A4

Ethical wellness care for the elderly is urgently needed as many residents in long term care are anxious, lethargic or depressed. Our society urgently requires more, and better, therapeutic options to deal with our aging, and increasingly long-lived population. Stats Canada estimates that close to 25% of Canadians will be over the age of 65 by 2036, increasing health-care costs and socioeconomic burdens. To deal with this challenge, Canada needs to develop innovative, evidence-based methods that can maintain wellness in the aging population without requiring an unsustainable increase in the number of caregivers. The Interactive Media Lab at the University of Toronto, with its extensive experience in human factors engineering and technology evaluation, will assist industry partner Praxis in evaluating its virtual reality (VR) for neurocognitive rehabilitation and preparing that technology for commercialization. Praxis has developed technology-enhanced mindfulness meditation (TEMM), which has shown promising results within a psychiatric practice. The motivation behind TEMM is to utilize knowledge of brain properties to provide immersive experiences that promote calm awareness, positive affect and sensory receptivity to external/environmental input. In this project we will evaluate the use and effectiveness of TEMM for seniors with cognitive impairment and dementia as a necessary step towards commercializing the technology. Praxis will refine its immersive multimedia suite based on our research results from field testing TEMM in long term care. The first phase of work will involve field testing and the second phase will involve scientific evaluation of TEMM in long term care and a comparative analysis of how TEMM outcomes vary across different settings (e.g., acute care vs. neuro-rehabilitation care vs. standard long term care). Outcomes assessed will include wellbeing, amount of stress-reduction and changes in cognitive function for people using the technology.

Project Leads
  • Mark Chignell, University of Toronto
Feasibility study of an interactive digital technology in reducing bathing-related agitation in a residential care facility – Workpackage 6.13-SIP A4
The MindfulGarden project comprises three feasibility studies exploring the use of interactive digital interventions to arrest and de-escalate anxiety and aggression in frail elderly suffering from hyperactive delirium and/or dementia. Two studies have been approved for implementation in September 2018. Fraser Health has approved a pilot study for Peace Arch Hospital to determine the efficacy of MindfulGarden in reducing hyperactive delirium. A concurrent study at Delta View will address hyperactive dementia in long term care. This application to AGE-WELL is in support of a third study at Delta View Rehabilitation Centre validating MindfulGarden as an important treatment in reducing bathing-related agitation in dementia residents. Bathing is well recognized as an activity associated with resident stress and aggression and violence against caregivers. In a study of 1,565 ‘bath sessions’ administered to long-term care dementia residents, 46.8% involved some degree of agitated behaviour, with 27.5% involving actual physical resistance (Cooke, 2006; Cooke & Gutman, 2005). A 2014 report from the University of Lethbridge also shows aggression and caregiver distress, with 40% of staff reporting feeling powerless and emotionally drained on a routine basis. (Source: Spenceley, S. 2015). There is an urgent need for new tools and treatments that can reduce residents’ stress in the bathing environment. In Cooke’s study, of six factors examined including air and water temperature and type of bathtub, increased privacy and the presence of windows in the bathing area were statistically significant in reducing physical agitation during bathing. MindfulGarden offers a digital approximation of the natural environment that might be viewed from a window. It combines a waterproof TV screen with sensors that respond to patient vocalization and movements to trigger a visual ‘garden’ that has been shown at proof-of-concept in 2016 to de-escalate challenging behaviours associated with delirium and dementia so that care can continue (demo:
Project Leads
  • Gloria Gutman, Simon Fraser University
PATHFINDER: A Smart Lighting System for Fall Prevention and Wayfinding for Seniors – Workpackage 6.14-SIP A5
Project Leads
  • M. Cynthia Goh, University of Toronto