The Adherence Promotion with Person-centered Technology (APPT) Project: Promoting Adherence to Enhance the Early Detection and Treatment of Cognitive Decline

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Many older adults experience declines in cognitive ability that can be substantial, including mild cognitive impairment and Alzheimer’s disease and AD-related dementia. Population aging, coupled with age-related cognitive impairment, including Alzheimer’s disease and other dementias, represents an unprecedented challenge. Early detection of cognitive impairment is a crucial goal. This would allow individuals at risk for mild cognitive impairment and/or AD/ADRD to adopt lifestyle changes to minimize decrements and the risk for acquired cognitive impairment. However, the massive potential of cognitive training and longitudinal assessment to detect and prevent age-related cognitive impairment and dementia are unlikely to be realized unless individuals are willing and able to engage with these protocols for an extended period of time. Adherence to cognitive assessment and training is often poor. Addressing the gap between potential and realized benefits of early detection and prevention of cognitive impairment is an urgent goal as the population ages. The aims of the Adherence Promotion with Person-centered Technology (APPT) project are to promote early detection and treatment of age-related cognitive impairment and dementia by 1) enhancing adherence to cognitive intervention and assessment protocols, 2) improving understanding of barriers to long-term adherence, and 3) assisting in the development of algorithms for predicting and preventing adherence failures. Projects aim to investigate these issues within samples of older adults with and without cognitive impairment. Two randomized controlled trials will test an adaptive, tailored, and integrated technology support system predicted to boost adherence to cognitive protocols, over and above a simpler scheduling and reminder system over 6 months. Studies will provide valuable and generalizable insight into not only the benefits of adherence support, but also the individual difference factors that shape protocol adherence (e.g., attitudes, cognitive ability, dementia status, health status, personality, technology proficiency). Data will inform the process of identifying individuals who would benefit from additional support, and predicting and preventing extended adherence failures before they happen. By increasing adherence, these studies will help improve early detection and treatment of cognitive impairment, which will ultimately extend older adults' functional independence, improving their lives and the lives of their families, and reducing care and support resources needed to address lost independence like that associated with Alzheimer’s disease and AD-related dementia. Further, intervention studies for dementia and Alzheimer’s disease can be made more efficient through tools for identifying individuals likely to experience decline before substantial cognitive impairment has occurred. Results have implications that extend far beyond cognitive impairment; the methods and mechanisms uncovered have broad implications for technology-mediated assessment and protocols to enhance health and well-being in general. The project consists of two large randomized controlled trials and smaller needs assessment and usability studies that will guide their development and deployment.