ADL+: a digital toolkit for cognitive assessment and multidomain intervention for prevention of cognitive decline in community-dwelling older adults – a proof-of-concept study (Preprint)

Abstract

Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline.

To evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function, activity levels, and quality-of-life in older adults at risk of cognitive decline. Adherence and usability were also evaluated.

We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score≥2). Participants received a 6-month intervention (app-based cognitive training, personalised nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains–attention, processing speed, memory, and executive function). Secondary outcomes were activity levels (Frenchay Activities Index, FAI), and quality-of-life (EQ-5D). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed effects models.

At six months, the intervention group showed a significant NTB composite score improvements (mean change: 0.086 (95% CI 0.020-0.15)), with a between-group difference of 0.17 (95% CI 0.071-0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in processing speed domain at nine months. The control group's FAI scores declined at six months (mean change: -1.04 (95% CI -1.83- -0.26)), while the intervention group's scores remained stable. The intervention group's EQ-5D Visual Analogue Scale (VAS) scores improved at both six and nine months with between-group differences of 4.06 (95% CI 0.23-7.90) at six months and 5.12 (95% CI 0.81-9.43) at nine months. Adherence was high, while average usability scores were obtained.

The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality-of-life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts.

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