Our past studies focused on 1) understanding the breakdown of everyday action performance, including the mechanisms involved in everyday error detection and correction populations with moderate-level cognitive impairment and 2) developing strategies to improve everyday action in these populations (i.e., everyday action interventions).

Goal 1: UNDERSTANDING The Breakdown of Everyday Action

Everyday Action in Dementia Project: Our work supported a new conceptualization of everyday action impairment, called the Omission-Commission Model. In contest to previous models, the Omission-Commission Model conceptualizes two general types of errors when performing everyday tasks. Omission errors (i.e., failure to complete task steps) are associated with declarative memory deficits (i.e., episodic memory encoding and task knowledge) and the volume of the medial temporal lobe and hippocampus. By contrast, commission errors (i.e., performing task steps inaccurately; e.g., incorrect sequence or with wrong objects, etc.) are associated with executive functioning and the integrity of the deep white matter in the brain. Our work has shown that people with different dementia syndromes, which are associated with different cognitive profiles, show different patterns of errors when performing everyday tasks.

Everyday Action Measurement Project: Our laboratory has relied heavily on the Naturalistic Action Test (NAT), a performance-based test of everyday action with an elaborate error coding taxonomy to characterize performance. We have developed variants of the NAT items and elaborated the error coding methods to test specific hypotheses and to evaluate error detection and everyday task knowledge.

Everyday Action in Schizophrenia Project: We characterized everyday action errors and error detection in people diagnosed with chronic schizophrenia and found the large majority of errors were commissions. People with schizophrenia were typically capable of completing everyday task goals (i.e., few omissions) but were highly disorganized, repetitive and inefficient when doing so.  Everyday action impairment in people with schizophrenia is best explained by executive dysfunction.

Validation of Smartphone-Derived Digital Phenotypes for Cognitive Assessment in Older Adults: Digital phenotyping is an emerging methodology that relies on passive collection of sensor data right from your smartphone during everyday life to measure activities, behaviors, and mood. It is possible that overarching patterns of de-identified sensor data (for example, how often you unlock your phone screen, how varied your day-to-day movements are) can be tied to underlying cognitive and functional ability and may be useful for detecting early changes associated with cognitive decline. In collaboration with Dr. Ian Barnett from the Department of Biostatistics Epidemiology and Informatics at the University of Pennsylvania and Dr. Chiu Tan from the Department of Computer and Information Science at Temple University, this project evaluated the validity of a digital phenotyping protocol to characterize cognition and function among diverse older adults across the continuum of cognitive ability level, from healthy aging to mild dementia. The ultimate goal of this project is to develop an ecologically valid, efficient, and sensitive measure of everyday function to be used in clinical and large-scale research settings.

Naturalistic Eye Movements as Clinical Markers of Everyday Cognition in Older Adults: Eye tracking and virtual reality (VR) have emerged as potential sensitive and scalable methods for studying such changes. Results of this study will help develop a highly sensitive, scalable assessment for cognitive skills most critical for everyday functioning in a diverse aging population and 2) identify the cognitive mechanisms underlying mild functional difficulties to inform future development of targeted interventions. 

Smartwatch Derived Digital Phenotypes in Older Adults: Brain structures that regulate and control the autonomic nervous system (i.e., locus coeruleus) have been identified as the earliest affected regions of neurodegenerative disorders, including Alzheimer’s disease. Thus, passive measurement of autonomic functions, including day-to-day variability of physical activity, sleep, and heart rate may offer a highly sensitive measure of early cognitive difficulties with numerous advantages (e.g., relatively inexpensive, non-invasive, portable, discrete, not affected by education, culture, or test anxiety, etc.). The aim of this proposal was to validate continuous measures of autonomic function against standard clinical tests of cognitive abilities, performance-based and questionnaire measures of everyday function, brain imaging measures of cerebrovascular integrity (white matter hyperintensities), and brain health (volume and function of locus coeruleus). Strong relations between physiological variables and clinical measures would provide preliminary support for using smart watches to help monitor cognitive function and characterize neuropsychological health in a variety of older adults.

Goal 2: EVERYDAY Action INTERVENTION

Task Training: While a graduate student in the Temple Cognitive Neuropsychology Laboratory, Dr. Brianne Bettcher developed and tested a method for enhancing knowledge of everyday tasks in people with dementia, called “Task Training.”  Task Training was designed to be delivered immediately preceding task performance and targeted problems with everyday error monitoring by boosting task knowledge. Results with the intervention showed significantly lower error rates and significantly higher error detection following a brief Task Training interval.  Training stimuli are available here for download:

• General Task Training Instructions
• Task1 (Task1 part1; Task1 part2)
• Task2  (Task2 part1)
• Task3  (Task3 part1; Task3 part2; Task3 part3)
• Script Content Quiz

Personal Object Project: We identified an advantage for personal objects on tasks of semantic knowledge and use in people with Alzheimer’s disease. People with Alzheimer’s disease demonstrated richer semantic associations and more accurate use gestures when presented with their own, personally familiar objects relative to exemplars of the same object provided by the examiner (i.e., their comb vs. a comb provided by the examiner). This effect was observed even when people were not able to reliably distinguish their own personal object from the examiner’s object. This finding suggests that to optimize everyday function in people with dementia we must ensure that they use objects that are highly familiar to them or provide opportunities for object training.

Strategic Object Placement Project: We have demonstrated the placement of objects in the workspace significantly influences everyday action performance in people with dementia and people with schizophrenia. Most people benefit greatly from the strategic placement of objects in the workspace (i.e., placing objects in the order in which they should be used in a task and removing distractor objects from view).

The Effect of Goal Cues on Everyday Action in Dementia: Goal cues may be used to remind people of a task goal to prevent decay of task schema and keep individuals on track. We have shown that reminders about task goals greatly reduces the number of omission errors but does little to change the number of commission errors. In fact, goal cues were only effective at significantly improving performance for individuals with a large number of omission errors. This finding underscores the importance of careful characterization of everyday action impairment and indicates that in order to maximize the benefit of behavioral interventions, we must match intervention strategies to peoples’ specific functional deficit profiles.

Feasibility of the SmartPrompt for Improving Everyday Function in Dementia: People with dementia experience difficulties completing everyday tasks, such as remembering to take medications, leading to secondary health issues, caregiver burden, and high medical care costs. With our collaborator, Chiu Tan in the Department of Computer and Information Science at Temple, this project evaluates the feasibility and usability of a smartphone-based prompting application informed by neuropsychological data and theory. By leveraging the technology capabilities of personal smartphones, the SmartPrompt is designed to promote accurate completion of everyday activities in older adults with dementia. The ultimate goal of this project is to promote aging in place and reduce caregiver burden.

Improving Everyday Task Performance through Repeated Practice in Virtual Reality: Cognitive training leads to reliable improvements on the specific task(s) that are repeatedly practiced, but transfer to untrained, functional tasks is limited. Because of both limited transfer and rigid (procedural) learning in AD, novel language-based interventions for dementia have focused on repeated practice with a circumscribed and highly personalized vocabulary to maintain functional communication. Repeated practice of everyday tasks (leveraging intact procedural memory) also has been shown to improve performance of trained tasks in people with AD but is not a feasible intervention, because the effort required to set up tasks, monitor performance, and provide feedback/supervision is far greater than having a caregiver simply complete the task for the patient. In collaboration with Takehiko Yamaguchi from the VR and Data Science Lab at Suwa University of Science in Japan, this project evaluated the efficacy of a low-cost computer training program that uses non-immersive virtual reality (VR) to enable participants with AD to independently practice meaningful everyday activities (e.g., meal preparation).

Goal 3: COLLABORATIVE Projects 

Mechanisms and Treatment Strategies to Counter Addiction Susceptibility Post TBI: This project is a sub-aim of a large, multidisciplinary study that includes investigators from several departments at Temple University and Temple Medical School, Drexel University, and the Coatesville VA. In collaboration with the Temple Olson Lab, this project evaluated concussed and non-concussed athletes with behavioral testing and brain imaging to determine relations between cerebral white matter integrity, cognitive abilities, addictive behavior, and concussion symptoms.

Peri-Operative Cognitive Function in Older Adults Undergoing Cardiac Surgery: This collaborative project with Thomas Floyd and Catherine Price examines cognitive and neurologic outcomes in older adults who undergo cardiac surgery.