Digital tools for people in pre-dementia stages: a scoping review (Preprint)
Authors: de Rijke Tanja J. , Engelsma Thomas , Ng Chi Him , Kaijser Kyra K.M. , Nap Henk Herman , Smets Ellen M.A. , Visser Leonie N.C. 
Published: August 2024

BACKGROUND

The field of Alzheimer’s disease (AD) moves towards earlier diagnoses in pre-dementia stages, personalized prognosis, and dementia prevention. In the near future, a gap is expected between the growing demand for Alzheimer-related healthcare and a shrinking workforce. Responsibility is increasingly assigned to individuals to take an active role in their own brain health. Digital tools are thought to offer support with regard to these processes.

OBJECTIVE

The aim of this scoping review is to create an overview of digital tools published in scientific literature in the context of Alzheimer’s disease and dementia, with cognitively unimpaired people and/or people in pre-dementia stages as primary end-users interacting with these digital tools. Additionally, we aim to gain insight into study sample diversity, the stage of maturity and evaluation of these tools, and recommended future directions.

METHODS

PubMed, IEEE Xplore, Ovid, and Web of Science were searched in January 2023, using terms on Alzheimer’s disease and dementia, (pre-)disease stages, digital tools, and purposes of digital tools. Two independent reviewers screened 2811 records on title and abstract, and subsequently 408 full text articles, based on in- and exclusion criteria. Articles on tools targeting those with an Alzheimer’s disease or dementia diagnosis were excluded. Data extraction included information on the sample characteristics, the digital tool, stage of maturity and evaluation, and future (research) directions.

RESULTS

We included 39 articles, which were aimed at primary prevention (15/39; 38.5%), secondary prevention (10/39;25.6%), daily life support (8/39; 20.5%), diagnosis and risk assessment (4/39;10.3%), or decision-making (2/39; 5.1%). Variation in study sample emerged regarding cognitive abilities (healthy (11/39; 28.2%); mild cognitive impairment (11/39; 28.2%), (subjective) cognitive impairment (10/39; 25.6%); ‘no dementia’ (1/39; 2.6%), and variation of cognitive abilities (6/39; 15.4%)). Less variation was found regarding sex (>50% female: 27/39; 69.2%), education ( >50% high education: 13/39; 33.3%), and age (>50% >60 years: 23/39; 59%). Few articles reported on ethnicity (12/39; 30.7%) and digital literacy (11/39; 28.2%). Most tools were in an early evaluation and maturity stage (31/39; 79.5%), comprising pre-prototyping (1/35; 2.9%), prototyping (15/35; 42.9%), pilot testing (19/35; 54.3%), efficacy testing (18/40; 45%), usability testing (12/40; 30%), and feasibility testing (10/40; 25%). Future (research) directions comprise the need for further tool development, attention to diversity, and study advancements, such as large-scale longitudinal studies.

CONCLUSIONS

79.5% of tools as reported on in academic literature are considered to be in an early maturity stage. Studies and evidence gathered for digital tools for people (at risk) in pre-dementia stages is thus preliminary and further developments and research is needed before these tools can be implemented for assessing, supporting and preventing cognitive decline.