Technology will Save us All! (or, Cognitive Orthotics for Aging Baby Boomers)

Technology will either save us all, or be our undoing. Of course, at times, it seems like both is the case. What with internet addiction in all its forms (online gambling, shopping, porn, even illegal drugs being so easily available), the enabling of unconstitutional, mass dragnet spying by the National Security Agency, the supposed disconnection of society in favor of cold, disembodied online relationships – these are all real concerns. Perhaps they’re the price to pay for the disruptiveness of technological innovation brought to us by the Information Technology (IT) revolution, but they are real problems that need to be grappled with.

Anyways, even with all of these concerns, I tend to be of the type that sees technological innovation as a potentially liberating force. I tend to see technology as something that just may save us all.

Take, for example, the case what the DSM-V now calls mild neurocognitive disorder (MNCD), thought in many cases to be a precursor, an “upstream condition” from full-blown dementia (although in many cases it can resolve, or simply remain a chronic condition). Originally called mild cognitive impairment and developed and expounded on most notably by Ronald C. Peterson, M.D, Ph.D. of the Mayo Clinic, it’s a syndrome that’s designed to note abnormality of cognitive functioning but not necessarily to the level of significant impairment of functioning. The diagnostic criteria can be summarized as follows:

1) the patient must have concern about their cognitive functioning (or concern can be noted by a family member or physician); in other words, there’s some real worries about the patients memory or cognitive functioning.

2) Upon formal testing, they show significant, albeit modest deficits in one or more areas of cognitive functioning,

3) They remain independent in their basic activities of daily living (bathroom, bathing, etc.) and also more complex activities (e.g., meal preparation, paying bills, etc).They may be slowed in their performance of these activities and make more errors, but they remain independent. Finally,

4) They are not demented.

Enter the world of cognitive orthotics. A cognitive orthotic is merely a fancy term for the high-tech version of something that speech therapists, neuropsychologists, and geropsychologists have been making use of with their patients for years in low-tech forms: external memory aids. Think calendars, address books, memo pads, and post-it notes.

One big difference between simple external memory aids and cognitive orthotics is the limited flexibility of traditional ‘paper and pencil’ types of external memory aids. Paper calendars are bulky, and have to be carried with you separately, you have to remember to enter events individually and manually on it, and you have to remember to check it. If a family member, caregiver, or assistant wants to enter events on your calendar for you, they have to be in possession of your calendar book in order to do it. Using paper calendars for external memory aids is clunky, cumbersome, and labor-intensive.

I recall when I was in college in the early 90s and I first started using a “Palm Pilot” (remember those?) – it was like a revelation. As opposed to paper calendars, I could add repeating items, I could add alarms and reminders to events, it was astounding what I could do and it actually made my life far more functional, such as it was. What I was using was a rudimentary cognitive orthotic.

Since then, the PDA (or personal digital assistant) has been made obsolete by the widespread adaptation of smartphones such as iPhones and Droids, and the use of ‘apps.’ The great leap forward here is that a smartphone can remain constantly connected to the internet, or “the cloud” and interface directly with a vast array of databases. Calendaring, reminders, and use of address books become far more flexible as they are no longer tethered to data held on your phone, and the computing power now available in your tiny smartphone easily eclipses many times over the power of expensive desktop computers available just a few years ago.

So, I ran across this article the other day, which touts electronic “prostheses for the mind” as a fix for mild cognitive impairment in aging baby boomer attorneys. This article piqued my interest because I can’t help but imagine that the lion’s share of the newly-diagnosed MNCD patients that will be seen over the coming years will be baby boomers, many of whom will still be working in skilled and professional trades, may be doctors and lawyers with many years of experience and knowledge, and really enjoy their work and have no desire to stop doing what they do.

On the one hand, if your lawyer was developing MNCD and you knew about it, would you want to have them as your attorney? On the other hand, what if there were some simple things this lawyer could be doing to remediate their condition and allow them to continue working effectively?

There were a number of applications discussed in this article, but the main one I looked into is called Vitacare, which is an app created by a Canadian company. Apparently two of the principal founders of the company have been personally touched by Alzheimer’s disease and created this application to assist family caregivers in helping their care recipient family members remain maximally independent within the home. Since launching the app, the company that makes Vitacare (emAPPetizer) landed a major contract with a residential care facility in Canada that provides care to over 250 individuals, and has made use of the app as a way to provide medication and other reminders to their residents, who suffer from a variety of mental handicaps, and allow them to live semi-independently.

There are other apps, such as PEAT for Android, and It’s Done! for iOS all have similar ideas behind them – allowing caregivers to make use of technology to assist people with memory problems in remaining independent and safe in the home by making use of shared calendars, remote messaging and to-do lists, and a variety of other features that connect caregivers and their loved ones, typically within a stripped-down, simplified interface (which is something I liked about the Vitacare app).

Other apps that have potential applications for people with memory problems are apps such as Find Your Car with AR for iOS – which, as the name suggests, provides a simple way for users to retrace their steps and locate their cars in busy parking lots (I’ve actually had this problem before, so I may actually want to get this app!). Also, there are a number of other apps that may not necessarily be designed for people with memory issues that may have some very useful applications for them like text-to-speech apps (such as Dragon Dictation) or Google Calendar with the shared calendar and alarm functions – the latter of which I personally use and swear by.

So bottom line, although there’s currently relatively few market players in the ‘cognitive orthotics’ sector, I have no doubt this will in the near future be a booming business that’s ripe for innovation. If you’re a caregiver, or a person with memory problems who has an interest in making use of these kinds of apps, great! I think this a great thing to try. However, I would recommend the following before you try any of these apps:

1)     If you or your memory-impaired loved one were not a smartphone computer user previously, or are not comfortable with technology, this is not for you, obviously.

2)     These kinds of apps are appropriate for those with mild neurocognitive disorder (or mild cognitive impairment, as it used to be called), or perhaps some mild dementia with generally otherwise preserved functioning. Those with more advanced dementia probably won’t benefit from these kinds of technologies, and the downside of using them if a person is too impaired to benefit may be unnecessary frustration or disappointment, or perhaps even a false sense of security!

3)     Try to make use of a free trial for the app in question. If the developer isn’t offering a trial, email the company that makes the app and ask for one (they may be able to do one anyways).

4)     Realize that these apps will not be a panacea. In many cases, particularly in the case of older adults with newly-diagnosed dementia or mild neurocognitive disorder of the Alzheimer’s type, these types of memory problems will progress over time and these ‘cognitive orthotics’ will lose their effectiveness. Also, recognize there is currently not much formal research in the area of cognitive orthotics, particularly as regards these commercial available entities.

However,  in many cases, these kinds of technologies hold some exciting promise – much like using a walker can extend the independence of a person who suffers from ambulatory issues, using these ‘cognitive orthotics’ can extend the independence of a person who suffers from memory issues. And isn’t that a great thing?

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