ADL+: A Digital Toolkit for Multidomain Cognitive, Physical, and Nutritional Interventions to Prevent Cognitive Decline in Community-Dwelling Older Adults

Justin Chew (), Zhiwei Zeng, Toh Hsiang Benny Tan, Pamela Chew, Noorhazlina Ali, Hao Wang, Melissa Ong, Roslyn Raymond, Kalene Pek, Di Wang, Liang Zhang, Zhiqi Shen, Cyril Leung, Jing Jih Chin, Wee Shiong Lim and Chunyan Miao
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Justin Chew: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
Zhiwei Zeng: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Toh Hsiang Benny Tan: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Pamela Chew: Department of Psychology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Noorhazlina Ali: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
Hao Wang: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Melissa Ong: Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore 308433, Singapore
Roslyn Raymond: Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore 308433, Singapore
Kalene Pek: Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore 308433, Singapore
Di Wang: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Liang Zhang: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Zhiqi Shen: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Cyril Leung: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore
Jing Jih Chin: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
Wee Shiong Lim: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
Chunyan Miao: Joint NTU-UBC Research Centre of Excellence in Active Living for the Elderly (LILY), Nanyang Technological University, Singapore 639798, Singapore

IJERPH, 2024, vol. 22, issue 1, 1-17

Abstract: Background: Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline. Objectives: To evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function, activity levels, and quality of life in older adults at risk of cognitive decline. Adherence and usability were also evaluated. Methods: We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score ≥ 2). Participants received a six-month intervention (app-based cognitive training, personalized nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was a change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains: attention, processing speed, memory, and executive function). Secondary outcomes were activity levels (Frenchay Activities Index, FAI), and quality of life (EQ-5D). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed-effects models. Results: 96% of participants in the intervention and 89% in the control group completed the study. At six months, the intervention group showed a significant NTB composite score improvement (mean change: 0.086 (95% CI 0.020 to 0.15)), with a between-group difference of 0.17 (95% CI 0.071 to 0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in the processing speed domain at nine months. The control group’s FAI scores declined at six months (mean change: −1.04 (95% CI −1.83 to −0.26)), while the intervention group’s scores remained stable. The intervention group’s EQ-5D visual analogue scale (VAS) scores improved at both six and nine months, with between-group differences of 4.06 (95% CI 0.23 to 7.90) at six months and 5.12 (95% CI 0.81 to 9.43) at nine months. Adherence was high, while average usability scores were obtained. Conclusions: The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality of life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts.

Keywords: cognition; artificial intelligence; dementia; prevention; multidomain intervention; technology; aging; digital (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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