Contemporary societies are facing a dramatic, pervasive increase in age-related cognitive impairment, such as dementia. Dementia is characterized by a slow and progressive decline of declarative memory and cognitive abilities resulting from various pathological conditions that cause brain cell damage. As a consequence of cognitive decline, demented people lose their independence and their capacity to live autonomously. Cognitive impairment is the largest cause of dependence worldwide, and about half of all people with dementia depend upon personal care to carry out daily activities and represent a significant cost for healthcare systems. The ability to remember to carry out planned daily activities at the appropriate temporal and spatial conditions (i.e. prospective memory) is indeed a significantly and consistently compromised cognitive function in demented people, and possibly also in elderly people who complain of a reduced intellectual efficiency but who are otherwise cognitively and neurologically unaffected. An efficient prospective memory capacity is fundamental to preserve independence and autonomy in daily life, to preserve social relations within the community, and to comply with own health needs. The project presented in this chapter aims at fostering independence and autonomy in elderly people without or with early clinical signs of dementia by improving their working memory and prospective memory capacity through the adoption of assistive smartphone technology. From a technological point of view, the project aims at leveraging the recent developments in mobile and context-aware computing to be able to provide “smart” suggestions to individuals by automatically analysing their environment and recognizing locations and time frames that are well suited to the completion of user's tasks. In this chapter, the authors describe the social, clinical, and economic motivations of the project and its technological development.
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Alzheimer’s Disease International (ADI) published global prevalence data on dementia in the World Alzheimer Report 2009, based on a systematic review of 154 studies conducted worldwide, and United Nations population projections through to the year 2050. We estimated 36 million people with dementia in 2010, nearly doubling every 20 years to 66 million by 2030 and to 115 million by 2050 (World Health Organization & Alzheimer’s Disease International, 2010).
Figure 1.
Increase in numbers of people with dementia worldwide (2010 – 2050)
Europe wide, demographic forecast number of demented patients in Europe will rise substantially in the above-mentioned years. Currently, there are over six million people with dementia in the EU and, with the aging of the baby boomer generation, managing dementia in the elderlies is one of the greatest challenges that Europe will have to face in the next 50 years (Kaplan et al., 2013).
Europe gave a sign in strongly considering the dementia problem toward the end of 2009, when the first report of the European Research Area Board (ERAB) placed aging and healthcare among the grand challenges on the road toward Europe’s Renaissance. Particularly, in the “smart pillar” of the strategy, aging is among the objectives of the flagship initiative “Innovation Union” (i.e. ‘technologies to allow older people to live independently and be active in society’ will be one of the first “European Innovation Partnerships” to be funded).
Such initiatives arise in the context of a dramatic, pervasive increase of age-related cognitive impairment faced by contemporary societies, including in particular dementia. Dementia is characterized by a slow and progressive decline of declarative memory and cognitive abilities resulting from various pathological conditions that cause brain cell damage. The most common type of dementia is Alzheimer's disease (AD). With over 35 million cases worldwide (World Health Organization & Alzheimer’s Disease International, 2013) it constitutes one of the major causes of disability, and a major public health and financial burden for societies in general with costs that will escalate proportionately with numbers affected, and with increased demand for formal care services, particularly in low and middle-income countries. Indeed, the financial costs of managing dementia are enormous because the cost of illness is high in terms of both public and private resources. “In high-income countries, informal care (45%) and formal social care (40%) account for the majority of costs, while the proportionate contribution of direct medical costs (15%) is much lower. In low-income and lower-middle-income countries direct social care costs are small, and informal care costs (i.e. unpaid care provided by the family) predominate”, states the report of the World Health Organization & Alzheimer’s Disease International, (2012).