ALZHEIMER’SALZHEIMER’SMemory aids from a distributed Memory aids from a distributed

cognition perspectivecognition perspective

ByByOlly SwantonOlly Swanton

Laura MisselbrookLaura MisselbrookSusannah RedheadSusannah RedheadPeter Gomez-LuquePeter Gomez-Luque

PS30017Controversies in Cognition

Presentation OutlinePresentation Outline

Two case studies reflecting both sides of the Two case studies reflecting both sides of the controversy.controversy.

Dementia - Definition, Cause, FeaturesDementia - Definition, Cause, Features Case Study 1 - Guide Me ProjectCase Study 1 - Guide Me Project ControversyControversy Distributed CognitionDistributed Cognition Memory aidsMemory aids Case Study 2 - Gloucester Smart HouseCase Study 2 - Gloucester Smart House Conclusion and DiscussionConclusion and Discussion

Dementia: the Facts.Dementia: the Facts.

DefinitionDefinitionBriggs (1989) Briggs (1989)

OccurrenceOccurrenceHagnell et al (1981)Hagnell et al (1981)

CauseCause

FeaturesFeatures

‘‘Guide Me’ ProjectGuide Me’ Project

With the advancements of technology, its potential With the advancements of technology, its potential can be utilized in order to bring benefit to the lives can be utilized in order to bring benefit to the lives of those suffering with Alzheimer’s. of those suffering with Alzheimer’s.

Guide Me Project – undertaken by Dept. of Guide Me Project – undertaken by Dept. of Industrial Design, University of Eindhoven.Industrial Design, University of Eindhoven.

Integrates GPS & GSM technologiesIntegrates GPS & GSM technologies

Locator Locator and and communicationcommunication product for product for Alzheimer’s patients.Alzheimer’s patients.

AimAim

In the early stages of the disease, patients will In the early stages of the disease, patients will suffer from temporary memory loss, also known suffer from temporary memory loss, also known as ‘blackouts’.as ‘blackouts’.

These can occur at any time and often cause the These can occur at any time and often cause the patient to lose track of their own whereabouts. patient to lose track of their own whereabouts.

Becomes a worry for caregivers of the patient.Becomes a worry for caregivers of the patient.

ConceptConcept

Non-intrusive channelNon-intrusive channel

Patient can go about his/her daily life without Patient can go about his/her daily life without constant supervision from caregiver.constant supervision from caregiver.

Prolong the period of care that can be administered Prolong the period of care that can be administered by the caregiverby the caregiver

Delaying the admission into an Alzheimer's institute. Delaying the admission into an Alzheimer's institute.

Guide Me ResearchGuide Me Research Interviews conducted Interviews conducted Socially active people Socially active people

whom want to whom want to maintain their current maintain their current lifestyles.lifestyles.

Maintain Self Maintain Self preservationpreservation

Accept that there are Accept that there are social limitationssocial limitations

ScenariosScenarios

Scenario 1:- Scenario 1:- due to a blackout.due to a blackout. location of patient on location of patient on

map, with respect to map, with respect to where he/she is where he/she is heading to.heading to.

Scenario 2: Scenario 2: Emergency signal on Emergency signal on

the device. the device. Provide reassurance Provide reassurance

to the caregiver and to the caregiver and patient, in any case of patient, in any case of emergency, that there emergency, that there is help at hand.is help at hand.

Conclusions of Guide Me Conclusions of Guide Me ProjectProject

Harness GSM and GPS technologies Harness GSM and GPS technologies Simple deviceSimple device Living situation for the partner and patient Living situation for the partner and patient

more bearablemore bearable Alleviating stressAlleviating stress Ultimately, prolonging the time that a Ultimately, prolonging the time that a

patient can stay at homepatient can stay at home

Controversy!Controversy!

A paradox - to become more independent, A paradox - to become more independent, and thus assure better quality of life, and thus assure better quality of life, cognition is distributed between both cognition is distributed between both caregivers and technology. caregivers and technology.

Independence? Ethical concerns Independence? Ethical concerns emphasised. emphasised.

Distributed CognitionDistributed Cognition Devised over last 12 years by Hutchins, Clark, Devised over last 12 years by Hutchins, Clark,

Minsky, Lakoff.Minsky, Lakoff.

Reconceptualises what is considered cognitive. Reconceptualises what is considered cognitive.

Hutchins (1995) – Cognitive ethnography on Hutchins (1995) – Cognitive ethnography on board US Navy ships.board US Navy ships.

Three Central TenetsThree Central Tenets

Caroll (2002), Hutchins (1995)Caroll (2002), Hutchins (1995) Socially distributed –Socially distributed – social organisation social organisation

itself is a form of cognitive architecture itself is a form of cognitive architecture Embodied –Embodied – Organisation of mind an Organisation of mind an

emergent property of interactions among emergent property of interactions among internal/ external resourcesinternal/ external resources

Culturally embedded –Culturally embedded – Study of cognition Study of cognition not separable from study of culturenot separable from study of culture

Distributed Cognition cont. Distributed Cognition cont.

New theoretical foundation for HCINew theoretical foundation for HCI

Carmien 2003 - Carmien 2003 - Increasing workplace Increasing workplace independence for people with cognitive independence for people with cognitive disabilities by leveraging distributed cognition disabilities by leveraging distributed cognition among caregivers and clients. among caregivers and clients.

Emphasises mediating tools and social Emphasises mediating tools and social processes by which patients cognition is spread. processes by which patients cognition is spread.

Support groups (social configurations)Support groups (social configurations) MAPS (Memory Aid Prompting System)MAPS (Memory Aid Prompting System)

Memory AidsMemory Aids

A device or strategy which can be used by A device or strategy which can be used by a patient suffering memory loss in order to a patient suffering memory loss in order to store information or to alert a user to an store information or to alert a user to an event or an issue which might otherwise event or an issue which might otherwise be forgotten.be forgotten.

Generic techniques such as paper and Generic techniques such as paper and pen techniquespen techniques

Advanced electronic devices. Advanced electronic devices.

DefinitionDefinition

These combinations of external representations These combinations of external representations and physical tools have greatly extended and and physical tools have greatly extended and supported people’s ability to carry out cognitive supported people’s ability to carry out cognitive activities. (Norman, 1993)activities. (Norman, 1993)

Main goals which have cognitive benefits:Main goals which have cognitive benefits: 1. Externalizing to reduce memory load1. Externalizing to reduce memory load 2. Computational Offloading2. Computational Offloading 3.Annotating and cognitive tracing3.Annotating and cognitive tracing

External Memory AidsExternal Memory AidsChanges to your routine which help jog memoryChanges to your routine which help jog memory

DiaryDiary PDA’s (Personal PDA’s (Personal

Digital Assistants)Digital Assistants) Alarm Clocks/TimersAlarm Clocks/Timers PagersPagers Lists on Memo Lists on Memo

Boards/Post it NotesBoards/Post it Notes

Leaving physical Leaving physical items as reminders items as reminders i.e. leave items you i.e. leave items you need to take with you need to take with you by the front door.by the front door.

Where’s my house?Where’s my house?

Gloucester Smart-HouseGloucester Smart-House

Technology for maintaining independenceTechnology for maintaining independence

The developmental stageThe developmental stage

Technology in the HouseTechnology in the House

Bath and Basin MonitorBath and Basin Monitor

Night LightNight Light

Cooker MonitorCooker Monitor

‘‘Rula’Rula’

‘‘Enable Project’Enable Project’

Evaluation of the Gloucester HouseEvaluation of the Gloucester House

Quality of lifeQuality of life

The carers and the sufferersThe carers and the sufferers

ConclusionConclusion

Guide Me Project – cognition distributed Guide Me Project – cognition distributed between caregivers and technology. between caregivers and technology.

Smart Houses – more genuine independence.Smart Houses – more genuine independence. However – from distributed cognition However – from distributed cognition

perspective, others are implicated in cognition perspective, others are implicated in cognition regardless of whether cognitive deficit. regardless of whether cognitive deficit.

Iterative design process – ethical concerns can Iterative design process – ethical concerns can be taken into account. be taken into account.

Conclusion cont. Conclusion cont.

Distributed cognition affords framework for Distributed cognition affords framework for design and evaluation of digital artefacts. design and evaluation of digital artefacts. Hutchins – Memory processes in airport Hutchins – Memory processes in airport cockpit. cockpit.

However, does not address potential for However, does not address potential for learning. learning.

Carmien 2003Carmien 2003

ReferencesReferences Carmien, S., Gorman, A., DePaula, R., & Kintsch, A. (2004) Carmien, S., Gorman, A., DePaula, R., & Kintsch, A. (2004) Increasing Increasing

Workplace Independence for People with Cognitive Disabilities by Workplace Independence for People with Cognitive Disabilities by Leveraging Distributed Cognition among Caregivers and Clients. Leveraging Distributed Cognition among Caregivers and Clients. ACM ACM Portal, Vol. 13, Issue 5-6.Portal, Vol. 13, Issue 5-6.

Department of Health, (2004) Department of Health, (2004) Memory Aids and techniques, Memory Aids and techniques, Online, Online, Available HTTP: Available HTTP: www.mhra.gov.ukwww.mhra.gov.uk (Accessed May 2005) (Accessed May 2005)

Hollan, J., Hutchins, E. & Kirsch, D. (2000) Hollan, J., Hutchins, E. & Kirsch, D. (2000) Distributed Cognition: Toward a Distributed Cognition: Toward a New Foundation for Human-Computer Interaction ResearchNew Foundation for Human-Computer Interaction Research, ACM , ACM Transcations on Computer-Human Interaction, Vol. 7. No. 2.Transcations on Computer-Human Interaction, Vol. 7. No. 2.

Loh, J., Schietecat, T., Fai Kwok, T., & Lindeboom, L. (2004) Loh, J., Schietecat, T., Fai Kwok, T., & Lindeboom, L. (2004) Technology Technology Applied to Address Difficulties of Alzheimer Patients and Their PartnersApplied to Address Difficulties of Alzheimer Patients and Their Partners. . ACM Portal.ACM Portal.

References 2References 2 Briggs, R. S. J. Briggs, R. S. J. Alzheimer’s Disease: The clinical contextAlzheimer’s Disease: The clinical context in: Davies, D.C. in: Davies, D.C.

(Ed) (1989) Alzheimer’s Disease: Towards an understanding, John Libby & (Ed) (1989) Alzheimer’s Disease: Towards an understanding, John Libby & Company Ltd: London.Company Ltd: London.

Carmien, S., Depaula, R., Gorman, A. and Kintsch, A. (2004) Carmien, S., Depaula, R., Gorman, A. and Kintsch, A. (2004) Increasing Increasing workplace independence for people with cognitive disabilities by leveraging workplace independence for people with cognitive disabilities by leveraging distributed cognition among caregivers and clientsdistributed cognition among caregivers and clients. Computer Supported . Computer Supported Cooperative Work, 13, pp443-470.Cooperative Work, 13, pp443-470.

Loh, J., Schietecat, T., Kwok, T.F. and Lindeboom, L. (2004) Loh, J., Schietecat, T., Kwok, T.F. and Lindeboom, L. (2004) Technology Technology applied to address difficulties of Alzheimer patients and their partnersapplied to address difficulties of Alzheimer patients and their partners. . [online] ACM International Conference Proceeding Series, ACM Press: New [online] ACM International Conference Proceeding Series, ACM Press: New York.York.

Giere, R.N. (1996) Giere, R.N. (1996) Models as parts of distributed cognitive systemsModels as parts of distributed cognitive systems. In: . In: Magnani, L. and Nersessian, M. (2000) Model Based Reasoning: Science, Magnani, L. and Nersessian, M. (2000) Model Based Reasoning: Science, Technology, Values. Kluwer University Press: New York.Technology, Values. Kluwer University Press: New York.

References 3References 3 Clare, L., Roth, I., Wilson, B., Carter, G. and Hodges, J. (2002) Clare, L., Roth, I., Wilson, B., Carter, G. and Hodges, J. (2002)

Relearning face-name associations in early Alzheimer’s Disease.Relearning face-name associations in early Alzheimer’s Disease.

Neuropsychology, 2002, Vol 16, No.4, pp538-547. Neuropsychology, 2002, Vol 16, No.4, pp538-547.

Adlam, T and Orpwood, R. (2002) Adlam, T and Orpwood, R. (2002) The Gloucester Smart HouseThe Gloucester Smart House, Online, Online

Available Available www.dementia-voice.org.uk/projects/projects_gloucesterproject.htmwww.dementia-voice.org.uk/projects/projects_gloucesterproject.htm (Accessed May 2005)(Accessed May 2005)

Preece, J. (2002) Preece, J. (2002) Interaction DesignInteraction Design

Wiley Press, U.KWiley Press, U.K