Mild Cognitive Impairment (MCI) and Dementia

Mild Cognitive Impairment (MCI) and Dementia Gap Analysis focuses on issues and techniques for improving inclusion and quality of life for people with dementia and MCI using ICT. Our strategy includes a key ambition to develop ICT techniques that will work better for people affected by dementia; and to define, develop and improve dementia and aging-friendly ICT.

Many people are able to age in good health and remain active participants in society throughout their lives. Others experience physical and cognitive limitations, and may lose the ability to live independently. Memory loss can often increase with age but it is only when this is abnormal that it gets classified as Mild Cognitive Impairment or, if worse as one of the forms of dementia, such as Alzheimer’s
Although dementia mainly affects older people, it is not a normal part of aging.

The most elder-rich period of human history is upon us. How we regard and make use of this windfall of elders will define the world in which we live.

There is a good phrase to remember regarding people with dementia: "If you've met one person with dementia, you've met one person with dementia". This has been largely attributed to the late Tom Kitwood, although no direct source has been found.

Description of Dementia and Cognitive Decline

Dementia is defined as a severe loss of cognitive abilities that disrupts daily life. Symptoms include memory loss; mood changes; visual perception; focus challenges; and problems with communicating, decision making, and reasoning. Dementia is not a normal part of growing old. It is caused by diseases of the brain, the most common being Alzheimer's. Dementia is progressive, which means the symptoms will gradually get worse.

Description of Alzheimer's

Alzheimer's disease (62% of those with dementia): A physical disease caused by changes in the structure of the brain and a shortage of important chemicals that help with the transmission of messages. In short, Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills.

Statistics are from 2013 UK Study. Need to map with WHO and others.

Description of Less Common (Non-Alzheimer's)

Set of non-Alzheimer's Dementia diseases:

  • Vascular Dementia (17%): Caused by problems in the supply of blood to the brain, commonly caused by a stroke or a series of small strokes.
  • Mixed Dementia (10%): A type of dementia where a person has a diagnosis of both Alzheimer's disease and vascular dementia.
  • Dementia with Lewy bodies (4%): One of the less-common forms of dementia, it is caused by irregularities in brain cells, leading to symptoms similar to Alzheimer's disease, and Parkinson's disease.
  • Rarer causes of Dementia (3%): There are many rarer causes of diseases and syndromes that can lead to dementia or dementia-like symptoms, including Corticobasal degeneration and Creutzfeldt-Jakob disease.
  • Fronto-temporal Dementia (2%): Rare when all ages are taken into account, but relatively common in people under 65, it is a physical disease that affects the brain.

Statistics are from 2013 UK Study. Need to map with WHO and others.

Cognitive Function

This section is a technical reference. Jump to the next section on Symptoms for more practical information.

Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1. [[Trewin-1]] (Contributed by Katherine Deibel)
Cognitive-Function Decline Due to Dementia

Overview: The parts of the brain and cognitive functions affected depend upon the type of dementia.

Alzheimer's

Alzheimer's: Specific Causes are being researched, but scientists note a buildup of two abnormal proteins (amyloid and tau), which damage nerve cells in the brain. The proteins form different types of clumps, plaques or tangles, which interfere with how brain cells work and communicate with each other. Plaques are usually first seen in the area of the brain that makes new memories (the hippocampus of the medial temporal lobe), but then moves to other parts of the brain as the disease progresses.

Auditory Discrimination

Whenever the temporal part of the brain becomes diseased, people with dementia have difficulty making sense of sounds. They may lose the ability to follow conversations or become abnormally sensitive to sound. People can also become uncertain about the location of sounds. Social situations and music may be more difficult to enjoy.

Visual Recognition Skills

In Posterior Cortical Atrophy, a rare form of Alzheimer's, the parietal and occipital lobes of the brain are affected by the same abnormal proteins found in Alzheimer's. This causes difficulty in seeing where and what things are.

Phoneme Processing

In fronto-temporal dementia, the temporal lobe is affected, causing difficulty with speech and language.

Cross-modal Association

People with Alzheimer's disease have a buildup of abnormal proteins in the hippocampus, which causes it to malfunction. This affects the ability to recognize places. They may become disoriented.

Working Memory

In Alzheimer's disease, the buildup of abnormal proteins in the Hippocampus affects the ability to store new memories.

When the temporal lobe is affected by fronto-temporal dementia, it causes difficulty in recollection of factual information.

Behavioral

Fronto-temporal dementia is thought to be caused by proteins building up in the frontal lobe of the brain. People often experience changes in personality and behave inappropriately.

Physical

In corticobasal degeneration, the cortex and basal ganglia become damaged, which is currently thought to occur due to the overproduction of the tau protein. This causes movement to be stiff or jerky, and affects one or more limbs.

Consciousness

Dementia with Lewy bodies affects the cerebrum where small round lumps of proteins build up, and can cause fluctuations of consciousness, as well as hallucinations, delusions (firmly held beliefs in things that are not real), and false ideas (such as paranoia).

Symptoms

Overview: The parts of the brain affected and the specific symptoms depend upon the type of dementia.

Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1.  To be determined
Common Symptoms of Cognitive Decline Due to Both MCI and Dementia
  1. Difficulty remembering information (tends to fluctuate as the day progresses, and decline over long periods of time).
  2. Difficulty with organizing thoughts.
  3. Difficulty working within time limits.
  4. Visual processing difficulties, which can affect the ability to recognize places.
Symptoms of Cognitive Decline Due to MCI
  1. Memory: Sometimes forget names or appointments, but then remember them later.
  2. Problem Solving: May make occasional errors when balancing a checkbook.
  3. Completing Tasks: May need occasional help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about the day of the week, but then figures it out later.
  5. Visual/Spatial/Temporal Understanding: May have vision changes related to cataracts, low vision, and/or color/contrast perception. May have some hearing or speech loss. May have diminished motor ability and acuity. May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Sometimes have trouble finding the right word.
  7. Misplacing Items: May misplace things from time to time, and then need to retrace their steps to find them.
  8. Judgment: May make a bad decision once in a while.
  9. Withdrawal: May, on occasion, feel weary of work, family, and social obligations.
  10. Mood/Personality: May develop very-specific ways of doing things, and therefore may become irritable when a routine is disrupted.
Symptoms of Cognitive Decline Due to Dementia
Symptoms of Alzheimer's
  1. Memory: Often or completely forgetting names or appointments.
    1. Forgetting recently-learned information.
    2. Forgetting important dates or events.
    3. Asking for the same information over and over.
    4. Forgetting to check expiration dates on food.
    5. May have problems recognizing familiar faces of family or friends.
    6. Increasing need to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
  2. Problem Solving: Changes in ability to develop and follow a plan; or work with numbers.
    1. May have trouble following a familiar recipe, or keeping track of monthly bills.
    2. May have difficulty concentrating and take much longer to do things than they did before.
  3. Completing Tasks: Often find it hard to complete daily tasks.
    1. May have trouble driving to a familiar location.
    2. May have trouble managing a budget.
    3. May have trouble remembering the rules of a favorite game.
    4. May have difficulty in completing tasks that involve multiple steps (ex. laundry).
  4. Confusion w/Time or Place: Can lose track of dates, seasons, their location, and the passage of time.
    1. May have trouble understanding something if it is not happening immediately.
    2. May forget where they are or how they got there.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading; speaking; hearing; judging distance; and determining color or contrast. Often have diminished-motor ability and acuity. This may cause problems with driving.
    1. May have difficulty understanding/distinguishing mechanical and electronic sounds and alerts. (including some of the very tools that are meant as memory aids) May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: Often have trouble following or joining a conversation.
    1. May stop in the middle of a conversation, and have no idea how to continue, or may repeat themselves.
    2. May struggle with vocabulary, have problems finding the right word, or call things by the wrong name (e.g., calling a "watch" a "hand-clock").
    3. May lose ability to speak.
  7. Misplacing Items: Often put things in unusual places.
    1. Often lose things, and are unable to go back over their steps to find them again.
    2. Sometimes may accuse others of stealing their misplaced items (may occur with increasing frequency).
  8. Decreased Judgment: Experience changes in judgment or decision-making.
    1. Often use poor judgment when dealing with money, giving large amounts to telemarketers.
    2. Often pay less attention to grooming or keeping themselves clean.
  9. Withdrawal: May start to remove themselves from hobbies, social activities, work projects, or sports.
    1. May have trouble keeping up with a favorite sports team, or remembering how to complete a favorite hobby.
    2. May avoid being social because of the changes they have experienced.
  10. Mood/Personality: Can become confused, suspicious, depressed, fearful, or anxious.
    1. May be easily upset at home, at work, with friends, or in places where they are out of their comfort zone.
  11. Confabulation: 'the production of statements or actions that are unintentionally incongruous to the subject's history, background, present and future situation" Dalla Barba (1993).
Symptoms of Less-Common Dementia (Non-Alzheimer's)
  1. Memory: Sometimes forgetting names or appointments; and sometimes remembering them later.
  2. Problem Solving: Make occasional errors when balancing a checkbook.
  3. Completing Tasks: Often need help to use the settings on a microwave or to record a television show.
  4. Confusion w/ Time or Place: May get confused about dates, seasons, their location, and passage of time, which usually comes back to them.
  5. Visual/Spatial/Temporal Understanding: May have difficulty reading; speaking; hearing; judging distance; and determining color or contrast. May have diminished motor ability and acuity. May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
  6. Conversation: On occasion, may have trouble following or joining a conversation. Sometimes, may have problems finding the right word.
  7. Misplacing Items: May put things in unusual places, but can usually find them by retracing their steps.
  8. Decreased Judgment: On occasion, may experience changes in judgment or decision-making.
  9. Withdrawal: May, on occasion, withdraw from work or social activities
  10. Mood/Personality: May, on occasion, become confused, suspicious, depressed, fearful, or anxious.
Typical behaviors exhibited by people with Dementia
  1. Repetitive Behavior - Asking the same question over and over again. As well as memory loss, this can be due to the people's feelings of insecurity, or anxiety about their ability to cope.
    1. Repetitive phrases or movements - This can be due to noisy or stressful surroundings; or boredom. It can also be a sign of discomfort, e.g., too hot or cold.
    2. Repetitive actions - Actions, such as repeatedly packing and unpacking a bag, or rearranging chairs in a room, may relate to a former activity.
    3. Repeatedly asking to go home - This can be a sign of anxiety, insecurity, fear, or depression. The concept of 'home' might evoke memories of a time or place of comfort and safety. People may not recognize their present environment as their home, even if it is the place where they live.
    4. Multiple phone calls - Some people with dementia phone their loved ones over and over again, particularly in the middle of the night. They may forget they have already called; or may be insecure or anxious.
  2. Restlessness
    1. Pacing up and down - Pacing may indicate a desire to use the toilet, but an inability to say that. Alternatively, pacing may indicate a feeling of frustration, and wanting some fresh air.
    2. Fidgeting - Someone with dementia may fidget constantly.
  3. Shouting and Screaming
    1. People may continually call out for someone; shout the same word; or scream or wail over and over again. They could be experiencing difficulties with visual perception or hallucinations.
    2. People with dementia may feel lonely or distressed. If their short term memory is damaged, they may not remember that someone is in the next room, and believe they are alone. They may feel anxious about their failing memory; bored; or stressed by too-much noise and bustle.
  4. Lack of inhibition
    1. Some people with dementia may undress in public, having forgotten when and where it is appropriate to remove their clothes.
    2. Apparently-inappropriate sexual behavior may be a result of the physical damage to the part of the brain that allows recognition of acceptable social behaviors.
    3. Some actions, such as lifting a skirt or fiddling with flies, may simply be a sign that the person wants to use the toilet.
    4. The person may behave rudely, for example, by insulting people, by swearing, or by spitting.
  5. Night-time Waking
    1. Many people with dementia are restless at night, and find it difficult to sleep. Older people often need less sleep than younger people in any case. Dementia can affect people's body clocks. They may get up in the night, get dressed, or even go outside.
  6. Trailing and Checking
    1. Living with dementia makes many people feel extremely insecure and anxious. This can result in constantly following their carers or loved ones around, or calling out to check where they are. A few moments may seem like hours to a person with dementia. They may feel safe only if other people are nearby.
  7. Hiding and Losing things
    1. People with dementia sometimes hide things and then forget where they are, or forget they have hidden them at all. The wish to hide things may be due to feelings of insecurity, and a desire to hold on to what little they still have.
  8. Suspicion
    1. Some people with dementia can become suspicious. If they have mislaid an object, they may accuse someone of stealing it, or they may imagine that a friendly neighbor is plotting against them. These ideas may be due to failing memory, or an inability to recognize people,
  9. Sleeplessness and ‘sundowning'
    1. Many people with dementia, especially in the middle stages, experience periods of increased confusion at dusk, with their disorientation continuing throughout the night. These periods, of what is known as 'sundowning', usually diminish as dementia progresses. (1)
ICT Challenges
Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1. [[Nunes-1]] (Contributed by Katherine Deibel)
  2. [[Sato-1]] (Contributed by Katherine Deibel)
Challenges
  • Remembering steps to complete a task, e.g., "How do I send an email?"
  • Overwhelmed by too many functions, complex UIs.
  • Copying information correctly.
  • Difficulty figuring out new UI metaphors.
  • Too many steps to complete a task.
  • Advertising prompts added before getting to a web page are confusing.
  • Menu systems are difficult to navigate and find the right path.
  • 15% of people living with dementia, an estimated 112,500 people (in the UK), have been victims of financial abuse, such as cold calling, scam mail, or mis-selling.
  • 62% of carers reported that the person they care for had been approached by cold callers or doorstep-sales people.
  • 70% reported that telephone callers routinely targeted the person they care for. Not only have people lost money, but they and their families have also suffered stress, exhaustion, and frustration as a result.
  • 76% of people reported having trouble managing their money, with a range of issues highlighted, such as the challenges of bank-security procedures; and a lack of dementia awareness in banks and other financial-services organizations. UK ONLY [[Chandaria-1]]
  • Mood/Personality: Controlling confusion and irritability when changes are made to their routine, environment, or location. Difficulty in feeling safe.
Scenarios and Use Cases that address Key ICT Challenges
Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1. [[Trewin-1]] (Contributed by Katherine Deibel)
  2. [[Wockl-1]] (Contributed by Katherine Deibel)
  3. [[Sato-1]] (Contributed by Katherine Deibel)
Scenarios
  • Struggling to remember recent events, but easily recalling things from the past.
  • Finding it hard to follow conversations or programs (on TV, web, video, webcast).
  • Forgetting the names of friends or everyday objects.
  • Repeating themselves, or losing the thread of what they are saying.
  • Problems with thinking and reasoning.
  • Feeling anxious, depressed, or angry about forgetfulness.
  • Other people starting to comment on their forgetfulness.
  • Confused, even when in a familiar environment (in space; and on TV, web, video, webcast).
  • A decline in the ability to talk, read or write.
Scenario A: Sending an Email

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and then know if the email has been replied to. A starts by turning on the computer.

Steps and Challenges for booking a train ticket online.
Step Challenges

Turn on computer.

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons. Firstly, people may find it hard to identify the power button, as they may have forgotten what it looks like. Secondly, some power buttons can be quite small, which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Launch email application.

This requires people to be able to identify the correct icon for their email application. Although there is a certain amount of intuitiveness surrounding the design of icons, sometimes, for the elderly, this can still be a problem. In this case, typing in the name of the email application (if that can be remembered) into the search bar on the start-up menu may help.

Select button to compose new email.

The majority of buttons with an email application are labeled. Therefore, people simply must read the icon labels until they find the correct one for 'new email'

Type in address of recipient.

If people are unable to remember the email address of the recipient, they can type the address in the box labeled "To". If people must access their address book to find the email address, they must select the address book (or contacts list) icon, and then type in the name of the person they wish to email. Their address should then come up. All of the above requires recognition and retrieval of information from long term memory, which could be a problem for those with memory problems.

Type in email subject.

Type a title for email into the subject box. This field is not mandatory. Therefore, if people are unable to enter any text in this field, the actual sending of the email will not be affected. However, most applications will show a warning message, such as "do you wish to send this email without a subject". People will still be enable to press "send" successfully.

Type content of email.

This should be fairly simple, provided people can remember what they wished to say in their email.

Send email.

The majority of email applications will have a clearly-labeled button for sending email.

Return to in-box.

In the majority of email applications, this step happens automatically after an email has been sent.

Minimize email application to background.

By selecting the third button from the left, in the top right-hand corner of the email application, people are able to minimize their emails. However, if people cannot remember what the "minimize" button looks like, or where it is located, this could be a problem for them.

Open email application from time to time to check if reply has been received.

The challenges associated with this step will be the same as the challenges associated with step 2.
Scenario B: Buying a Train Ticket Online

Scenario B is a gentleman in his early 50s who has recently been diagnosed with fronto-temporal dementia (early onset). He is trying to buy a train ticket online for a return journey the following day. At any point during this process, he may forget what he is doing, which could result in either no ticket being purchased or, alternatively, buying the wrong ticket. For example, he may wish to travel tomorrow, but purchase a ticket for the following week.

Steps and Challenges for booking a train ticket online.
Step Challenges

Turn on computer.

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons. Firstly, people may find it hard to identify the power button, as they may have forgotten what it looks like. To extend this further, people may have entirely forgotten what the computer is for, or where to find it. In this instance, the task becomes impossible until their memory returns. Secondly, some power buttons can be quite small. This may be difficult for those with reduced dexterity, particularly for those who are older, and may have arthritis or a tremor.

Open Internet browser.

Navigate home screen with mouse, identify web-browser icon, and select to open. Typical memory problems.

Type in URL for train ticket booking website.

Typing in the first few letters of the web address in the search bar should produce the URL.

Select icon for booking train tickets.

If the icon is not labeled, this could be difficult if people forget what the icon to buy tickets looks like. However, most icons for booking train tickets are clearly labeled. Therefore, the only issues for people should be recognizing the correct label, and remembering what they are doing.

Tick box for 'return'.

The user needs to remember that they need to purchase a return ticket in order to get home.

Type in from and to destinations.

Given that people start from their home address, it can be hoped their nearest train station is securely stored in their long term memory, and can be remembered. With regards to the destination, they are likely to have written this down when arranging the outing, which should help them remember the destination.

Select date and time for outbound & return journeys.

Choosing appropriate times for travel may be difficult for people with dementia. However, most train-ticket-booking websites do not allow booking a return journey prior to an outbound journey, so at least this potential problem is guarded against.

Select number of adult & child passengers.

In this instance, only 1 person is traveling. However, when more than 1 person is traveling, there is a higher possibility of the wrong number of tickets being purchased.

Tick box for rail cards. Select rail-card type and number that apply for this journey.

People are likely to have a rail card for seniors or persons with disabilities. Therefore, they must remember to apply their rail-card discount to the journey in order to get a discount.

Select continue.

-

Tick box for outward & return journeys (Details to look at: time, price, class, & single/return.).

This step involves selecting which type of ticket to purchase. Although all options are laid out in a table, sometimes it can be difficult to work out exactly which ticket to buy, and how much it costs.

Select 'buy now'.

-

Tick box to reserve seat and, if so, select seating preferences. This is optional. Therefore, if people do not understand it, it is perfectly fine for them to ignore this step.

Tick box to either: collect tickets from self-service ticket machine and select station; or have tickets sent by post.

Self-service ticket machines tend to be fairly complicated. Therefore, as long as there is enough time (7 days prior to start of journey), it is advisable to have the tickets sent by post.

Select 'continue'.

-

Tick box 'new user'.

If people have not used this particular ticket-booking site, they must enter all their personal details. Otherwise, they just need to remember their email address and password.

Type in personal details (Name, Address, Email, etc.).

Personal details need to be remembered.

Tick box 'payment card type' (Visa, MasterCard, etc.).

On the payment card, there is a symbol to indicate which type of card it is. This information must be entered by way of ticking the correct box.

Enter card details (number, expiration date, name, security code).

These are written on the payment card so there is no issue with memory impairment here. However, as with each step throughout this process, if people forget what they are trying to achieve at any point, they are unlikely to be successful in this task.

Type in post code and tick box find billing address.

Tick box to agree to terms and conditions and select 'buy now'

Enter payment card secure-bank password.

Order complete.
Scenario C: Online Supermarket Shop

Scenario C is a woman with dementia in her early 70s. She finds it easier to do her supermarket shopping online because she often gets confused in the shop, and forgets what she wants to buy.

Steps and Challenges for changing the payment details for an online supermarket shop.
Step Challenges

Turn on computer.

Identify and press the power button to turn the computer on. This may be difficult for a number of reasons. Firstly, people may find it hard to identify the power button as they may have forgotten what it looks like. Secondly, some power buttons can be quite small, which may be difficult for elderly people to press, especially those who have arthritis or a tremor in their hands.

Open web browser.

Navigate home screen with mouse, identify web-browser icon, and select to open. Typical memory problems.

Type in URL for supermarket shopping website.

Typing in the first few letters of the web address in the search bar should populate with previous history. However, if it is the first time, people may not understand how the automatic population of text works.

Select 'food and drink', and then 'buy groceries'.

Finding products and selecting a quantity may pose difficulty depending upon the user interface.

Log in with user name and password.

It may be difficult to remember the user name and password associated for this online store.

Delete old payment card

Select 'add payment card'.

Type in the card details.

These are written on the payment card so there is no issue with memory impairment here. However, as with each step throughout this process, if people forget what they are trying to achieve at any point, they are unlikely to be successful in this task.

Tick box 'make this my preferred payment card'.

Select 'save', and then either continue shopping or log out.
User Stories
Scenario A: Send an Email

Assumption: People have the screen in front of them, and it is already turned on.

Scenario A is an elderly person who has limited familiarity with computer devices (desktop, tablets, mobile). A would like to send an email to a family member. A needs to be able to find the mail program easily, interact with the user interface to compose and send an email, know that it has been sent, and then know if the email has been replied to. A turns on the computer.

Table of ICT Steps and Challenges for Sending an Email
Step Challenge Solutions Comments
1. Find the mail program. Search to find. What's the name/icon for the mail program?
2. Activate/open the program. Remember how to start up.
3. Navigate the UI Familiarize/remind themselves how to use it, understand icons/text labels, and understand how to increase the font size.
4. Locate email editor. Remember/find correct name for composing (compose, new).
5. Familiarize with the fields. Remember what each is used for/find the ones that are really needed vs. optional.
6. Insert Email addresses. How do I do that? What is an email address and what is its format?

Trouble remembering the name or email address for the person to send note to; confusion with pre-populating and word prediction; interaction with the Contacts feature; understand or ignore CC and BCC fields (solution: keep out); how to fix a wrongly-entered email address.
7. Subject Line Know that one is needed. Maybe pre-populate.
8. Write the Email. Not know/understand email conventions, confusion with spell checking; not understand editor features (bold, italic, color); challenges with adding an image/file; not know how to edit what has been written or how to start over; confusion if time-out occurs. Spell check - maybe turn off by default.
9. Send the email. Knowing when done (After it goes, where does it go, waiting for the recipient to respond immediately - is it like a phone call?).
10. Closing the Program. Remember how to do that, remembering that is needed.
11. Getting a Reply. How to know there is one? May be out of scope for this use case.
Scenario B: Turn up the Heat (using thermostat app).

Assumptions: People know they can do this from a remote device; they have the screen in front of them; it is already turned on.

Scenario B is an elderly person with early dementia. A daughter has demonstrated how to use a web-enabled mobile application to change the temperature of the house. Winter has arrived. B would like to turn the heat up to keep the house warm enough. B needs help recalling how to access the temperature program, the work flow to change the temperature, and understand the elements of the user interface.

Table of ICT Steps and Challenges for Turning up the Heat
Step Challenge Solutions Comments
1. Find the thermostat program (e.g., Nest). Search to find that control, remember what the control is called, remember where it is.
2. Activate/open the program. Remember how to start up.
3. Navigate the UI. Familiarize/remind themselves with it, understand icons/text names, understand how to increase font size.
4. Locate Temperature Control Feature. Remember/find correct name for changing (many UI versions, might be slider, button - how to use that - maybe unfamiliar non-intuitive for them), understand icons/text labels.
5. Manipulate the control up or down. How to control the level of the heat. (Is there a 2nd control?) Is that in degrees F or C? How to use/understand a slider feature?
6. Setting the desired temperature. How to do that? Understanding that a change has been set: does it save it automatically or does something have to be done to save it? Confusion if time-out occurs.
7. Closing the Program. Remember how to do that. Remembering that it needs to be done.
Personas
  • "I have great difficulty remembering things, working things out, and interpreting things. I use a Dictaphone, which helps considerably. I can't use a normal watch so I've gone digital, but that has its limitations. I can't read very well so I use audio books. I can't count money, but I haven't found a way around that yet, so any suggestions will be gratefully received! So, I've developed strategies to help. These can be very simple but effective if they work. Often, it is the simplest things that get the better of us - things we have done all our lives without a problem. But now, because we can't do them, it is very frustrating." - Extract from a speech by Ann Johnson at the Uk Dementia Congress, November, 2010.
How they use the web and ICT to include: email, apps, voice systems, IM.
Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1.  To be determined
{Section}

To do: Add table.

How people with Aging and Dementia can use optimized content and special pages.

To do: Add examples with descriptions of features that could optimize content for users.

Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1.  To be determined
Characteristics of Content Optimized for Aging and Dementia

Content for people with dementia and the elderly with cognitive decline:

  1. large, clear buttons with simple graphics and text;
  2. limited features;
  3. high contrast;
  4. clear, step-by-step instructions;
  5. rapid and direct feedback;
  6. simple, clear-writing style.

(Conclusions from The 14th international conference ICCHP 2014 - see below.)

Summary of Existing Research and Guidelines - Research Sources

Key features from Phiriyapkanon:

  1. Reduction of complexity: Factions that are rarely used, or are not necessary, should be removed.
  2. Clear structure of task: The starting points of tasks and every step should be easily recognized and understood.
  3. Consistency of information: Avoid contradictions and inconsistencies of information arraignment.
  4. Rapid and direct feedback: Applications should continuously provide easily-recognizable feedback of success or failure with every action.

They also should minimize errors; and provide on-screen help and high recover-ability. [[Phiriyapokanon-1]].

K Dobsz et. al. recommends:

  1. strong contrast of images with content;
  2. simple and large graphics;
  3. sound conformation of accepted and rejected operations;
  4. automatic-voicing reading tasks (instructions).

[[Dobsz-1]]

Key features from other guidelines:

  1. To help with difficulties in completing complex tasks, waiting until the elder completes one task before proceeding to the next step.
  2. Place tasks in step-by-step order.

Balance this because too-many steps can give a feeling of getting lost.

  1. One has to be consistent in naming steps, such as naming all steps beginning with a verb (such as "press the button").
  2. Orientation impairments cause elderly to unlearn how to find their way in new surroundings. Therefore:
    1. Menus and usability interfaces need to be simplified to minimize the amount of information that needs to be memorized.
    2. An application should work independent of other applications.
    3. The screen should not have distracting elements (wallpaper, buttons etc.).
  3. Information should be broken down into discreet chunks that the elderly can absorb.
  4. Content and information need to be consistent.
  5. Avoid stress that will further impair cognitive function.

[[Muskens-1]]

Key features for using tablets for the elderly from Dahn et. al.:

  1. The user interface should use widgets or large buttons rather then standard apps. Moving between screens should be possible using tabs or buttons, and not just gestures.
  2. Dedicated user interfaces often fall short of user requirements. Instead, populate the tablet with standard apps that have simple interfaces.
  3. Offer a PC-like mode with "file explorer" and familiar PC-interface features.
  4. Supply a printed manual.
  5. Privacy policies should be transparent to build trust.
  6. Supply a scaffolding approach to help and support, but allow flexible-entry points.

[[Dahn-1]]

  1. Older Equipment and Software: Some people who are aging or have dementia will be using older browsers and devices that might not be as capable or fault tolerant as current technologies; or may be missing some of the customized and interactive content provided by newer technologies.
Specific Technologies

To do: Add section

Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1. [[Sato-1]] (Contributed by Katherine Deibel)
Summary of Existing Research and Guidelines

To do: Add literary summary and insert guidelines and or references.

Use of Language and Communication for Dementias

[#LANG]

  • Avoid use of voice recognition or spoken commands from the end-user.
  • In either spoken or written information, use simple words, avoiding abstract, unfamiliar vocabulary.
  • In either spoken or written information, use simple sentences with just one idea per sentence. Avoid long sentences with embedded ideas.
  • Avoid pronouns or other forms of language that rely upon people having to recall information which they have just read or heard.
  • Support writing with clear visual images to account for potential vision deficits that have an impact on reading ability.
Extent to which current needs are met

Review challenges and describe where needs are met. Identify gaps.

Potentials and Possibilities (including current WCAG 2 Techniques)

Overview: This section maps higher-level challenges to existing WCAG 2 Techniques so that we can see where there are clear gaps that we will need to provide techniques for.

Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1.  To be determined
{Section}

Add ideas for filling gaps.

  1. Memory:
    1. enhanced use of color
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element. Perceivable
    2. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability". Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible". Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context. Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone". Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows which component on the web page has focus. Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available". Operable
      7. 2.4.2 - Page Title (A) says "web pages have titles that describe topic or purpose". (This is important for search results as the page title is usually displayed first in the listing.) Operable
    3. prompts and cues;
    4. index or table of contents;
    5. support text with redundant visual and auditory elements.
      1. 1.1.1 - Non-text Content (A) says "a text alternative that serves the equivalent purpose" is required. Perceivable
      2. 1.3.1 - Info and Relationships (A) says "information, structure, and relationships" to be made available, for example to text-to-speech software. Perceivable
      3. Software that visually highlights spoken text.
    6. help index
    7. Context Sensitive (support and) Help
      1. 3.1.3 Unusual Words (Level AAA) Understandable
      2. 3.1.4 Abbreviations (Level AAA) Understandable
    8. grouping and symmetry (to leverage visual perception and attention);
    9. intuitive design - ease of interaction (to leverage spatial memory);
      1. 2.1.1 - Keyboard (A) says "the content is operable through a keyboard interface". Operable
      2. 2.1.2 - No Keyboard trap (A) makes sure that keyboard focus "can be moved away from that component using only a keyboard". Operable
      3. 2.1.3 - Keyboard (No Exception) (AAA) says "all functionality of the content is operable through a keyboard interface". Operable
      4. 2.4.1 - Bypass Blocks (A) says "a mechanism is available to bypass blocks of content that are repeated". Operable
      5. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability". Operable
      6. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible". Operable
      7. 3.3.2 - Labels or Instructions (A) says that labels should be provided "when content requires user input". Understandable
    10. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    11. consistent identification;
    12. simplified user controls;
    13. error prevention and recovery;
    14. avoid distractions and seizures.
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio". Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content. Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed". Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  2. Problem Solving:
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. prompts and cues;
    3. logical work flow with redundant text, visual cues, and auditory cues;
    4. grouping and symmetry (to leverage visual perception and attention);
    5. intuitive design - ease of interaction (to leverage spatial memory).
    6. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    7. consistent identification;
    8. easy user customization;
    9. simplified user controls;
  3. Completing Tasks:
    1. prompts and cues;
    2. grouping and symmetry (to leverage visual perception and attention);
    3. intuitive design - ease of interaction (to leverage spatial memory);
    4. easy user customizations.
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    5. simplified user controls;
    6. error prevention and recovery;
    7. avoid distractions and seizures;
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio". Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content. Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed". Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  4. Confusion w/ Time or Place:
    1. Context and Orientation
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability". Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible". Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context. Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone". Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus. Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available". Operable
      7. 2.4.2 - Page Title (A) says "web pages have titles that describe topic or purpose" (this is important for search results as the page title is usually displayed first in the listing). Operable
    2. Identify current state.
    3. Consistent Navigation
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    4. consistent identification;
    5. simplified user controls;
    6. error prevention and recovery;
    7. Avoid Distractions and Seizures.
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio". Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content. Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed". Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  5. Visual/Spatial/Temporal Understanding: May want/need to combine "Confusion w/ Time or Place" and "Visual/Spatial/Temporal Understanding".
    1. Content Alternatives
      1. 1.1.1 - Non-text Content (A) Perceivable
      2. 1.2.1 - Audio-only and Video-only (Prerecorded) (A) Perceivable
      3. 1.2.2 - Captions (Prerecorded) (A) Perceivable
      4. 1.2.3 - Audio Description or Media Alternative (Prerecorded video) (A) Perceivable
      5. 1.2.4 - Captions (Live) (A) Perceivable
      6. 1.2.5 - Audio Description (Prerecorded video) (AA) Perceivable
      7. 1.2.7 - Extended Audio Description (Prerecorded video) (AAA) Perceivable
      8. 1.2.8 - Media Alternative (Prerecorded) (AAA) Perceivable
      9. 1.2.9 - Audio-only (Live) (AAA) Perceivable
      10. 1.4.7 - Low or No Background Audio (Prerecorded) (AAA) Perceivable
    2. large selection targets;
    3. zoom controls, large fonts.
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
    4. close proximity;
    5. context and orientation.
      1. 2.4.3 - Focus Order (A) says "components receive focus in an order that preserves meaning and operability". Operable
      2. 2.4.7 - Focus Visible (AA) requires an ability for the "keyboard focus indicator (to be) visible". Operable
      3. 2.4.4 - Link Purpose (In Context) (A) requires that the purpose of a link can be determined from the link text alone, or from the link text together with its surrounding context. Operable
      4. 2.4.9 - Link Purpose (Link Only) (AAA) says "a mechanism is available to allow the purpose of each link to be identified from link text alone". Operable
      5. 2.4.7 - Focus Visible (AA) requires a visible keyboard focus indicator that shows what component on the web page has focus. Operable
      6. 2.4.8 - Location (AAA) says "information about the user's location within a set of Web pages is available". Operable
      7. 2.4.2 - Page Title (A) says "web pages have titles that describe topic or purpose". (This is important for search results as the page title is usually displayed first in the listing.) Operable
    6. prompts and cues;
    7. support text with redundant visual and auditory elements;
    8. help index;
    9. context-sensitive help;
    10. plain language;
    11. grouping and symmetry (to leverage visual perception and attention);
    12. intuitive design - ease of interaction (to leverage spatial memory);
    13. consistent navigation.
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    14. consistent identification;
    15. enhanced use of color and contrast.
      1. 1.4.1 - Use of Color (A) requires that color is not used as the only visual means of conveying information, indicating an action, prompting a response, or distinguishing a visual element. Perceivable
      2. 1.4.3 - Contrast (Minimum) (AA) requires a contrast ratio of at least 4.5:1 for the visual presentation of text and images. Perceivable
      3. 1.4.6 - Contrast (Enhanced) (AAA) requires a higher contrast ratio of at least 7:1 for the visual presentation of text and images. Perceivable
    16. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    17. simplified user controls;
    18. error prevention and recovery;
    19. avoid distractions and seizures.
      1. 1.4.2 - Audio Control (A) says "a mechanism is available to pause or stop the audio". Perceivable
      2. 2.2.2 - Pause, Stop, Hide (A) says "a mechanism for the user to pause, stop, or hide" moving or blinking content. Operable
      3. 2.2.4 - Interruptions (AAA) says "interruptions can be postponed or suppressed". Operable
      4. 2.3.1 - Three Flashes or Below Threshold (A) Operable
      5. 2.3.2 Three Flashes (AAA) Operable
  6. Conversation:
    1. text;
    2. support text with redundant visual and auditory elements;
    3. simplified user controls.
  7. Misplacing Items:
    1. site map;
    2. index or table of contents;
    3. help index;
    4. context-sensitive help;
    5. consistent navigation.
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    6. consistent identification
  8. Judgment:
    1. prompts and cues;
    2. support text with redundant visual and auditory elements;
    3. grouping and symmetry (to leverage visual perception and attention).
  9. Withdrawal:
    1. easy user customizations
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    2. simplified user controls;
    3. error prevention and recovery;
    4. emotional expression (EmotionML).
  10. Mood/Personality:
    1. encouragement;
    2. immediate positive feedback;
    3. safety controls;
    4. grouping and symmetry (to leverage visual perception and attention);
    5. consistent navigation.
      1. 2.4.5 - Multiple Ways (AA) says "more than one way is available to locate a Web page within a set of Web pages". Operable
    6. consistent identification;
    7. easy user customizations.
      1. 1.4.4 - Resize Text (AA) says "text can be resized without assistive technology up to 200 percent without loss of content or functionality". Perceivable
      2. 1.4.8 - Visual Presentation (AAA) includes requirements on text style, text justification, line spacing, line length, and horizontal scrolling. Perceivable
    8. simplified user controls;
    9. error prevention and recovery;
    10. emotional expression (EmotionML).
Prevalence
Research Sources

These resources are relevant to this section. For our next draft, components of these articles will be incorporated into this section where applicable.

  1.  To be determined
Prevalence of Dementia
  • UK (2013 Study)
    • Alzheimer's Society estimates there are 428,000 people in the UK who are living with dementia that haven't been formally diagnosed.
    • Two thirds of people with dementia are women.
    • One in three people over 65 will develop dementia.
    • 40-64 years: 1 in 1,400
    • 65-69 years: 1 in 100
    • 70-79 years: 1 in 25
    • 80+ years: 1 in 6
    • Future Projections: The number of people in the UK with dementia will double in the next 40 years.
      • 800,000 people with dementia in 2012
      • 1,000,000 people with dementia in 2021
      • 1,700,000 people with dementia in 2051
Worldwide
  • There are an estimated 35.6 million people with dementia worldwide. By 2050, this figure will rise to over 115 million. (2)
  • There are 7.7 million new cases every year. [[WHO-4]]
  • Alzheimer's disease is the most common form of dementia, and may contribute to 60-70% of cases. [[WHO-4]]
  • In 2010, dementia had an estimated global cost of US $604 Billion, 1% of global GDP. [[ADI-1]]
By Gender
  • A study cited by the European Collaboration on Dementia (EuroCoDe) states that, in Europe, approximately 5 million women have dementia, compared with 2 and half million men. [[AE-1]] Cognitive decline is often accelerated in women following menopause. [[Thilers-1]]
Prevalence of Aging
  • World Health Organization: 2012 Study
    • The world population is rapidly aging.
      • Between 2000 and 2050, the proportion of the world's population over 60 years old will double, from about 11% to 22%. The number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
    • The number of people aged 80 and older will quadruple in the period 2000 to 2050.
      • By 2050, the world will have almost 400 million people aged 80 years or older.
    • By 2050, 80% of older people will live in low- and middle-income countries.
    • The main health burdens for older people are from non-communicable diseases, while the greatest causes of disability are visual impairment, dementia, hearing loss, and osteoarthritis.
    • Older people in low- and middle-income countries carry a greater disease burden than those in the rich world.
    • The need for long-term care is rising.
      • The number of older people, who are no longer able to look after themselves, is forecast to quadruple by 2050 in developing countries.
    • Effective, community-level primary health care for older people is crucial.
    • Supportive, "age-friendly" environments enable older people to live fuller lives, and maximize the contribution they make.
      • Creating "age-friendly" physical and social environments can have a big impact on improving the active participation and independence of older people.
    • Healthy aging starts with healthy behaviors in earlier stages of life.
    • We need to reinvent our assumptions of old age.
      • Society needs to break stereotypes and develop new models of aging for the 21st century. Everyone benefits from communities, workplaces, and societies that encourage active and visible participation of older people.
References to Research
References on Aging
  • World Health Organization: On Aging: [[WHO-3]].
  • W3C Developing Websites for Older People: How WCAG 2.0 Applies: [[WAI]].
References on Dementia
References on Alzheimer's
  • US: Alzheimer's Association: http://www.alz.org/.
  • UK: Alzheimer's Society: http://www.alzheimers.org.uk/site/index.php.
  • US: Where Alzheimer's Starts and How It Spreads (ScienceDaily Research News): [[CUMC-1]]
  • US: National Institute on Aging - Alzheimer's Disease Fact Sheet: [[NIA-1]]
  • Argentina: Eye movement when reading could be early indicator of Alzheimer's: [[Taylor-1]]
References on Less-Common Dementia (Non-Alzheimer's)

Less-Common Dementia (Non-Alzheimer's)

(2) Alzheimer's Society International (7) Fabian, D. & Flatt, T. (2011) The Evolution of Aging. [[Fabian-1]](8) www.senescence.info - Joao Pedro de Maglahaes [[De-Magalhaes-1]]

References from literature reviews on Dementia and ICT from Peter Cudd
INDIVUI
How Individual Should Digital AT User Interfaces Be for People with Dementia. [[Cudd-1]]

Abstract. A literature review of papers that have explored digital-technology. user-interface design for people with dementia is reported. Only papers that have employed target user input directly, or from other works, have been included. Twenty four were analyzed. Improvements in reporting of studies are recommended. A case is made for considering the population of people with dementia as so heterogeneous that one design does not suit all. This is illustrated through some case-study reports from people with dementia. Furthermore, it is proposed that, by grouping people into functionally-similar sub-groups, interfaces may be designed for these groups that will collectively establish a sequence of 'stepping stone' interfaces that better address appropriate functioning and maintain self-efficacy. Fundamentally, people living with dementia are unique individuals with unique specific needs. A priori, in life experiences, interests, willingness to learn, environmental factors, and co-morbidities, they are as varied as any of their age peers. One thing they do not share with those peers is the degenerative consequences of the specific dementia they have. The progression of their disease also follows a unique time line, even if the general symptoms (and thus perhaps functional ability) change in a fairly predictable order. In the face of these statements, it might be inferred that it is most likely people with dementia require individual but adaptive (to progression of the disease), bespoke solutions for sustained independent living.

Given the breadth of individuality in people, the effects of dementias, and indeed their progression, it is impossible to view them as a single, homogeneous population in terms of specifying a single user interface. In consequence, rather than simply designing for all people living with dementia, it is suggested that design for populations at stages of functional ability be investigated. Methods that set out to identify shared and bespoke requirements are needed to systematically establish any generalization. Currently, studies on design of digital AT, and indeed other ICT for people living with dementia, need to report much-more detail on: describing their participants; details of user interface features that worked well; and how much and what form carers' help took. More attention also needs to compare strategies and features that work to identify those that are best; or at least best for specific functional ability or tasks.

Key refs (as indicated by title)
[INDIVUI_10]
[[Alm-1]]
[INDIVUI_12]
[[Armstrong-1]]
[INDIVUI_13]
[[Astell-1]]
[INDIVUI_25]
[[Meiland-1]]
[INDIVUI_26]
[[O'Neill-1]]
[INDIVUI_27]
[[Orpwood-1]]
[INDIVUI_14]
[[Astell-2]]
[INDIVUI_17]
[[Davies-1]]
[INDIVUI_19]
[[Hellman-1]]
[INDIVUI_20]
[[Hyry-1]]
[INDIVUI_21]
[[Karlsson-1]]
[INDIVUI_23]
[[Lim-1]]
[INDIVUI_24]
User needs and user requirements of people with dementia: Multimedia application for entertainment. O. Maki, P. Topo. In: P. Topo and B. Ostlund (eds). Dementia, Design and Technology. Assistive Technology Research Series Vol. 24. IOS Press: Amsterdam. 2009.
[INDIVUI_30]
[[Savitch-1]]
[INDIVUI_32]
Designing ICT for the over 80s. E.L. Waterworth, J.A. Waterworth. In: P. Topo and B. Ostlund (eds). Dementia, Design and Technology. Assistive Technology Research Series Vol. 24. IOS Press : Amsterdam. 2009.
[INDIVUI_33]
Maavis : "Touchscreen computer helps care home residents keep in touch with family", British Journal of Healthcare Computing, 2010, available at http://www.bjhc.co.uk/archive/news/2010/n1010032.htm; Accessed on 26/03/13.
Others
[INDIVUI_2]
[[Topo-1]]
[INDIVUI_4]
[[Soar-1]]
[INDIVUI_9]
[[Alm-2]]
[INDIVUI_11]
[[Alm-3]].
[INDIVUI_16]
[[Boman-1]]
[INDIVUI_18]
[[Donnelly-1]]
[INDIVUI_22]
[[Kerkhof-1]]
LANG
[[Greasley-1]]

Abstract. The design of user interfaces for people with dementia does not appear, from the literature, to take into account the concomitant language and communication deficits when choosing the language used in the interfaces. A systematic approach was used to search databases for studies relating to language and communication in the four most-common forms of dementia (Alzheimer's disease, vascular dementia, fronto-temporal dementia and dementia with Lewy bodies). Studies identified were used as a basis for the commentary in this paper. Communication deficits are common in dementia. From the earliest stages of the disease, the person with dementia's capacity for communication declines as difficulties emerge with all aspects of language and functional communication. These deficits have implications for the successful interaction with assistive digital technology designed to improve the quality of life of people with dementia. More consideration should be given at the design stages to the potential impact of communication difficulties on interaction with technology.

It is important to note that the authors have not been able to find, to date, any conclusions about what impact these impairments may have on user interface design.

The results of this review have highlighted areas of strength (reading) and areas of difficulty (spoken-language output and understanding some aspects of spoken and written language) in the communication abilities of people living with dementia. Those who design interfaces for this client group should consider the impact that their language and communication choices might have on end-users with dementia. In particular, the following general guidelines should be taken into account, in order to maximize the accessibility of the language of interfaces for people with dementia.

Key refs (by title)
[LANG_3]
[[Lauriks-1]]
[LANG_6]
[[Meiland-1]]
[LANG_8]
[[Alm-4]]
[LANG_11]
Wallace, M. D. Mulvenna, S. Martin, S. Stephens, W. Burns. In: M. D. Mulvenna & C. D. Nugent (eds). Supporting People with Dementia Using Pervasive Health Technologies, London: Springer-Verlag. 2010.