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Assistive technology for cognition in HD

By: Marleen R. van Walsem, MSc, Emilie I. Howe, MSc and Jan C. Frich, MD, PhD

Original Article: van Walsem MR, Howe EI, Frich JC, Andelic N. Assistive Technology for Cognition and Health-related Quality of Life in Huntington’s Disease. J Huntingtons Dis. 2016 Oct 1;5(3):261-270.

Assistive technology for cognition (ATC) can be defined as any external device aimed at improving or maintaining functional abilities of individuals with cognitive impairment.1 ATC can specifically address disabilities in memory, executive functions (planning, organization and attention), and reduced psychomotor speed. ATC comprises devices that are easily accessible and readily employed by anyone (i.e. smartphones, post-it notes), and also complex high-tech devices or programs specifically developed for supporting cognitive abilities. ATCs are used as a supportive service, and have shown themselves to be a promising strategy in conditions characterized by cognitive disabilities, for example traumatic brain injury and Alzheimer’s disease.2

Progressive development of cognitive disability is a hallmark of HD. Given the nature of cognitive impairment in HD, including reduced planning and organization skills, attention deficits and reduced psychomotor speed, there may be a benefit of ATCs for patients with HD, including devices that support structuring everyday life and memory. However, to date no research has investigated the use of ATC in HD patients.

The aim of our study was to describe aspects of ATC, including ATC use, information, needs assessment, and training, in HD patients, and to explore the association between using ATC and health-related quality of life (HRQoL). We used a cross-sectional population-based study design that included 84 HD patients who lived in south-eastern Norway, who had a clinical diagnosis of HD across the five disease stages. In addition to information regarding aspects of ATC, we collected socio-demographic and clinical data including disease-specific information. A general evaluation of cognitive impairment was also performed. We used the Unified Huntington’s Disease Rating Scale (UHDRS) Total Functional Capacity (TFC) scale as a standardized measure of functional ability. Overall HRQoL was assessed using the EQ-5D Visual Analogue Scale. In order to describe the aspects regarding ATC use and provision, we used descriptive statistical analyses, and we used multivariate regression analyses to explore the association between ATC use and HRQoL.

Results of the descriptive analyses on ATC are presented in Table 1. We found that approximately one-third (36.9%) of the patients with HD used ATC. We also found that patients who used an ATC device were predominantly in stages I−III, with mild to moderate cognitive impairment. Regarding other aspects of ATC, less than half (44%) of patients had received information about ATC, less than one-third (32.1%) had undergone a needs assessment, and only one-fifth had received ATC training. Most of these patients were in stage III. Furthermore, TFC was identified to be the only variable that bore significant impact on HRQoL (β-value = -0.564; β 95% CI 1.47− 5.34; r2 = 0.142; p = 0.001) in our multivariate regression model, which explained 30% of the variance.

Our findings indicate relatively infrequent ATC use, information provision, needs assessment and training, especially considering that the progressive development of cognitive disabilities for which specialized ATC devices exist is an inevitable symptom of HD. The lack of association between ATC use and HRQoL may reflect a lack of awareness and knowledge about ATC availability and provision among healthcare professionals. Further research into the potential benefits of ATCs in supporting cognitive disabilities and thereby positively affecting functional ability and HRQoL is warranted. Future studies should employ disease-specific measures of HRQoL that may be more sensitive to disease-specific aspects of HRQoL. ATC may prove to be a beneficial addition to the existing healthcare services for patients with HD.

  Complete sample (N = 84) Stage I (n = 12) Stage II (n = 22) Stage III (n = 19) Stage IV (n = 14) Stage V (n = 17)  
Variables   n (%) n (%) n (%) n (%) n (%) n (%) P-value (2-sided)
ATC formal/ informal Formal Informal


12 (14.3)19 (22.6)

53 (63.1)

0 (0)9 (75)

3 (25)

4 (18.2)10 (45.5)

8 (36.4)

7 (36.8)0 (0)

12 (63.2)

1 (7.1)0 (0)

13 (92.9)

0 (0)0 (0)

17 (100)

P < 0.0001
ATC use Yes No

Used previously

30 (35.7)48 (57.1)

6 (7.1)

9 (25)3 (75)

0 (0)

14 (63.6)8 (36.4)

0 (0)

7 (36.8)12 (63.2)

0 (0)

0 (0)11 (78.6)

3 (21.4)

0 (0)14 (82.3)

3 (17.7)

P < 0.0001
ATC information* YesNo 37 (44)46 (54.8) 4 (33.3)8 (66.7) 10 (45.4)12 (54.5) 14 (73.7)5 (26.3) 4 (28.6))10 (71.4) 5 (29.4)11 (64.7) P = 0.045
ATC evaluation** YesNo 27 (32.1)56 (66.7) 0 (0)12 (100) 7 (31.8)15 (68.2) 12 63.2)7 (36.8) 4 (28.6)9 (64.3) 4 (23.5)13 (76.4) P = 0.006
ATC training YesNo 17 (20.2)67 (79.8) 0 (0)12 (100) 5 (22.7)17 (77.3) 7 (36.8)12 (63.2) 2 (14.3)12 (85.7) 3 (17.6)14 (82.4) P = 0.150

ATC: Assistive Technologies for Cognition/cognitive disabilities. Chi-squares were used to calculate overall group differences; * 1 missing in Stage V; **1 missing in Stage IV.

Table from van Walsem MR, Howe EI, Frich JC, Andelic N. Assistive Technology for Cognition and Health-related Quality of Life in Huntington’s Disease. J Huntingtons Dis. 2016 Oct 1;5(3):261-270. Published under a Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License.

1Scherer MJ, Hart T, Kirsch N, Schulthesis M. Assistive Technologies for Cognitive Disabilities. Crit Rev Phys Rehabil Med. 2005;17(3):195-215.

2Gillespie A, Best C, O’Neill B. Cognitive function and assistive technology for cognition: a systematic review. J Int Neuropsychol Soc. 2012;18(1):1-19.

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