Brain Stimulation “Alexa Skill”

For
Alzheimer’s Patients
Problem Statement and Proposal

BTE: Miqdad, Safin, Salma, and Jassim

Purpose, scope, and objective:

Alzheimer’s is the most common form of dementia. Dementia is a broad term for symptoms associated
with memory loss and other cognitive abilities. Alzheimer’s is a progressive disease that gradually
worsens over time. Dr. Barry Reisberg from New York University divides the period of Alzheimer’s into
seven stages based on the severity of the symptoms [1]. Stages one and two are the periods when
Alzheimer’s is not detectable by physicians or memory tests. It is from stage three when symptoms of
memory loss become evident, and the disease can be detected by doctors. Stage 5 is when the
symptoms become severe and the presence of a caregiver becomes necessary. The symptoms gradually
become worse in the following stages-6 and 7- when patients cannot carry out day to day activities on
their own. Along with cognitive and neural disabilities, patients develop other medical complications,
such as loss of bladder control.

Our project aims to improve the quality of life of Alzheimer’s patients through cognitive stimulation.
Cognitive stimulation refers to any activity that provides general stimulation for logical and creative
reasoning, concentration, and memory. Studies show that the effect of Alzheimer’s maybe delayed using
mentally stimulating activities [2]. We do not aim to cure Alzheimer's nor reverse its stages. Once a
person is diagnosed with Alzheimer's, the stages are inevitable. In this project, we are targeting patients
who are in stages three and four, which we will refer to as the “mild stage.” Our goal is to extend the
time span between stage three and stage five through cognitive stimulation.

Needs Analysis:

Alzheimer’s patients’ needs are derived from the symptoms and effects of the dementia since most of
the time they may not be able to identify the problem.

The very first and most commonly known issue they face is memory loss. According to research [1, 3], as
the dementia progresses they forget things such as names of family members, friends, objects, their
address and even where they are.

However, a lesser known difficulty is that depression is a comorbid condition in Alzheimer’s [4]. The
reason why this is not immediately or easily identified in patients is that it coincides with Alzheimer’s
symptoms of moodiness and withdrawn behavior [3].

Furthermore, depression is not the only psychological complication that they face. According to
Alzheimer’s Society, patients begin to exhibit behavior changes such as aggression or agitation [5]. In
fact, when a study was conducted to learn more about these non-cognitive symptoms to better
understand the disease, it was found that almost all patients faced some sort of behavioral and
psychological symptom including delusions, apathy, anxiety and hallucinations [6].

On the more physical end of the spectrum, in later stages patients lose their motor functions more
rapidly. Research into how different stages of Alzheimer’s Disease (AD) affects motor functions found
that the loss of physical abilities is not constant – as the case with cognitive skills – but rather
inconsistent throughout the different stages. In early AD, there may be little to no loss in physical
abilities; however, in the severe stage there is a sharp decline [7].
As we are focused on late mild to moderate stages of Alzheimer’s, loss of
motor functions is not a part of our scope.

Previous Solutions and Research:

With the advancement of technology, lots of development have come up to

improve the life of alzheimer’s patients and their caregivers. We have come
across the following mobile applications and assistive technologies that are
helpful to Alzheimer’s patients in their mild stage.

“It’s Done!” is an app for iPhones that helps people check their routine
tasks, such as locking the door, switching off the lights, and turning off the
stove [8]. Alzheimer’s patients’ caregivers can connect with the patient’s
account and set up tasks. Once a task is checked by the patient, the
caregiver and/or their relatives connected with the account, receive a
notification. This is useful not just for Alzheimer's patients, but it is a
universal app that can be used by common people. During this stage,
patients tend to forget these simple tasks, and this app provides a
convenient way to help patients remind to complete these tasks. More importantly, caregivers/patients’
relatives can track if the patient has responded to the tasks.

Another innovative application, called “Timeless”, is being designed by a 14-year-old girl, whose
grandmother is diagnosed with Alzheimer's [9]. It functions similar to “It’s Done!”, but it consists of an
excellent facial recognition feature that helps patients identify their close relatives and loved ones.
Other features, such as calendars, alarms, and reminders also exist that can be set up by the caregiver.
The app also consists of preprogrammed contact lists with photos that enable patients to easily
recognize people in their contact lists. This app also serve as a great memory aid, but more importantly,
the facial feature recognition controls the behavioral changes in patients. By identifying their relatives,
they can feel less ignorant about their surroundings and feel more inclusive with in the family.

Several games have been developed for brain exercise that helps patients
to engage their brain for mind, eyes, and hand coordination. “MindMate” is
an excellent example of such a game. It aims to stimulate patients’ brain
through fun and interactive puzzles, memory games, and other activities
that are simple, yet engaging. Studies show that games like MindMate can
reduce the effect of developing dementia by 29%. Further, by engaging
their mind in activities, they can release some of the stress and reduce
anxiety and loneliness [10].

These applications provide immense help to patients and their caregivers. However, it is important to
understand that mobile applications are not “old people” friendly. ​ ​Alzheimer's patients in stage three
and beyond are generally people who are over 65 years of age [11].
 This is why, Amazon Echo is a better alternative to mobile
applications. Amazon echo is a hands-free system that
incorporates the smart assistant called “Alexa”. It is
essentially an interactive software that works through
voice medium. Although the device is not specifically
designed for Alzheimer’s patients, there are features in it
that can be used by caregivers and patients. These features
include reminders for memory aid, riddles and music player
for entertainment, and calendars. This system is better
than cell phones because the patient only has to “talk” to
Alexa to retrieve its features. The reminders are also voice
reminders which are more convenient than notifications in phones. Further, certain “Alexa skills” have
been developed for Alzheimer’s patients. (What apps are to phones, Alexa skills are to Amazon Echo).

One such Alexa skill is called “My Life Story”. This skill narrates the significant life stories of the patient,
such as wedding, graduation, and other significant incidents in his/her life. This is a good way of
remembering patients’ life story which they tend to forget at mild stages. This skill also aims to
contribute to the mental well-being of the patient. From the reviews in the amazon online store website
and various blogs, it seems that the skill is bringing positive changes in patients’ lives by making them
feel inclusive in their families [12].

Another Alexa skill that Alzheimer people use is the “Elderly Alexa”. This is a direct alternative to “It’s
Done!” app. Caregivers can set up alarms that remind patients about their medicine plants. Then, Alexa
confirms if the medicine has been taken or not, and a response is sent to a remote caregiver. This is
better than “It’s Done!” because it requires no effort from the patient. Essentially, Alexa keeps
reminding the patient and waits for a “Yes or No” response before notifying the caregiver [13].

We realized that there are no Alexa skills that challenge Alzheimer's patients to make use of their
cognitive abilities. Since we know that games such as MindMate are excellent tools for slowing the
symptoms of dementia. Therefore, we plan to develop an Alexa skill that consists of fun, simple, and
interactive games catered completely towards Alzheimer’s patients.

Design Constraints:

● User-friendliness: The product must be easy to use by the patient. This requirement is especially
important for Alzheimer’s patients since using unnecessarily complicated product can aggravate
the condition. This is because it can cause the patient mental stress on top of that which is being
caused by the disease itself.

● Brain Stimulation effectiveness: The product must be able to effectively challenge and stimulate
the patient’s brain in a way which allows for the best prolongation effect of the moderate stage
of the disease.
Design Evaluation

Having defined the constraints of the design, it’s crucial to define how the satisfaction of each constraint
will be evaluated. Firstly, the team plans to satisfy the user-friendliness constraint by utilizing Amazon’s
alexa instead of a mobile application since it’s more usable by our target audiences, the majority of
whom are not adapted to the complexities of using mobile devices. Alèxa offers a better way of
interaction with the product through voice recognition. Secondly, satisfying the brain stimulation
effectiveness constraint requires making the product capable of stimulating the brain; which maximizes
the prolongation of the moderate stage of Alzheimer’s. For that to be done requires further research on
the design methods of brain stimulation applications.

Proposal

This report described the problem of Alzheimer’s disease and the lack of​ non-pharmacological treatment
that could delay the disease from reaching its severe stage. In order to resolve this issue, the team
intends to develop a software that stimulates and challenges the brains of Alzheimer’s patients who are
in the moderate stage of the disease; such that the this stage is prolonged as much as possible. The
team proposes creating the product through Amazon’s Alexa by adding a skill to it. The Amazon skill that
the team intends to create is a ​“brain stimulating game”.​ As previously mentioned, the game will be
specifically catered for the Alzheimer's patients. Namely, the game will have to be optimized to provide
adequate stimuli to the patient’s brain. Moreover, it could be utilized as a method to measure the
improvement or decline of the brain activity.
REFERENCES
[1] Alzheimer’s Association, “Stages of Alzheimer's,” ​Alzheimer's Disease and Dementia.​ [Online].
Available: https://www.alz.org/alzheimers-dementia/stages. [Accessed: 13-Mar-2019].

[2] ​A. Park, “Preventing Alzheimer's: Keeping the Brain Active May Not Affect Disease,” ​Time,​
10-Jun-2015. [Online]. Available: http://time.com/3916777/alzheimers-symptoms-delay/. [Accessed:
14-Mar-2019]

[3] Alzheimer’s Society,​ ​“Symptoms of Alzheimer's disease,” ​Alzheimer's Society​. [Online]. Available:
https://www.alzheimers.org.uk/about-dementia/types-dementia/alzheimers-disease-symptoms#conten
t-start. [Accessed: 13-Mar-2019].

[4] F. Novais and S. Starkstein, “Phenomenology of Depression in Alzheimer's Disease,” ​Journal of

Alzheimer's disease:JAD​, 2015. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/26401763.
[Accessed: 13-Mar-2019].

[5] Alzheimer’s Society,​ ​“Changes in behaviour,” ​Alzheimer's Society.​ [Online]. Available:

https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/behaviour-chang
es. [Accessed: 13-Mar-2019].

[6] Zidan, Melissa, Arcoverde, Cynthia, Vasques, Rios, Alexandre, Laks, Jerson, and Andrea, “Motor and
functional changes in different stages of Alzheimer's disease,” ​Archives of Clinical Psychiatry (São Paulo),​
2012. [Online]. Available:
http://www.scielo.br/scielo.php?pid=S0101-60832012000500003&script=sci_arttext&tlng=en.
[Accessed: 13-Mar-2019].

[7] Zidan, Melissa, Arcoverde, Cynthia, Vasques, Rios, Alexandre, Laks, Jerson, and Andrea, “Motor and
functional changes in different stages of Alzheimer's disease,” ​Archives of Clinical Psychiatry (São Paulo),​
2012. [Online]. Available:
http://www.scielo.br/scielo.php?pid=S0101-60832012000500003&script=sci_arttext&tlng=en.
[Accessed: 13-Mar-2019].

[8] ​A. Park, “Preventing Alzheimer's: Keeping the Brain Active May Not Affect Disease,” ​Time,​
10-Jun-2015. [Online]. Available: http://time.com/3916777/alzheimers-symptoms-delay/. [Accessed:
14-Mar-2019].

[9] ​“Timeless,” ​Timeless​. [Online]. Available: https://www.timeless.care/. [Accessed: 14-Mar-2019].

[10] S. X. staff, “Study shows video games could cut dementia risk in seniors,” ​Medical Xpress - medical
research advances and health news​, 16-Nov-2017. [Online]. Available:
https://medicalxpress.com/news/2017-11-video-games-dementia-seniors.html. [Accessed:
14-Mar-2019].

[11] M. D. Jonathan Graff-Radford, “Early-onset Alzheimer's: When symptoms begin before age 65,”
Mayo Clinic,​ 29-Mar-2017. [Online]. Available:
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048356
. [Accessed: 14-Mar-2019].
[12] “r/amazonecho - My Life Story - an Alexa skill for those with Alzheimer's.,” ​reddit​. [Online].
Available:
https://www.reddit.com/r/amazonecho/comments/8914x5/my_life_story_an_alexa_skill_for_those_wi
th/. [Accessed: 14-Mar-2019].

[13] Webmaster, “Amazon Echo and Alexa for the Elderly,” ​Tech​, 24-May-2017. [Online]. Available:
https://www.techenhancedlife.com/explorers/amazon-echo-and-alexa-elderly. [Accessed:
14-Mar-2019].