mHealth and mental health: the project SMART4MD at the service of people with Mild Cognitive Impairment and dementia

mHealth and mental health: the project SMART4MD at the service of people with Mild Cognitive Impairment and dementia

The Consorci Sanitari de Terrassa takes part at the development of solutions mHealth at the context of the program frame H2020

On November 22nd the research group Brain, Cognition and Behavior of the Consorci Sanitari de Terrassa (CST) organizes the TECHNOLOGY FOR ELDERLY AND HEALTH Conference: TRANSLATION TO THE MARKET. That conference will be to the Hospital de Terrassa. The objective is to donate to the population’s growth of our country, the opportunity that Silver Economy represents for the market and the different technological experiences funded by the Europe Union that have been developed for this segment of population.

Also, parallel of the problem to transfer to market these products, among the European projects that will be presented is the SMART4MD. This project is co-financed by the European Union under an EU Framework Programme for Research and Innovation –Horizon 2020-, with grant agreement number 643399. The project focuses on an EU-wide research involving 11 international partners. The consortium is integrated by Anglia Ruskin University Higher Education Corporation (coordinator of the project), Alzheimer’s disease Europe, Athena ICT Ltd, Handle My Health, Universidad Politecnica of Madrid, South Essex Partnership University NHS Foundation Trust, Sanitary Consortium of Terrace, DEX Innovation Centre, Servicio Andaluz of Salud, Blekinge Tekniska Hogskola and  Katholieke Hogeschool Limburg VZW. The Consorci Sanitari de Terrassa is a clinicalpartner that intervenes at the technological development of an app commissioning to realise the focus groups and the survey of feasibility. Besides it takes part actively at the clinical assay that has included a total of 368 participants. Taking into account that the assay has realised with subjects with cognitive deterioration and carers, altogether 736 individuals take part since the CST.
The project is focusing primarily on improving quality of life of people with mild cognitive impairment (MCI) or mild dementia and their carers. These pathologies have been object of several researches lately because of the high risk that diagnosed individuals have shown to develop dementia. The first description for MCI was proposed during the decade of 1990 by Flicker, Ferris and Reisberg (1991) referring to a group of patients with cognitive deterioration without dementia and that showed a significant decline of their cognitive capacities after two years. The prevalence of the MCI depends largely on the criteria used, that goes from a 3% to a 42% in elderly people (Ganguli et al., 2010; López et al., 2003).

Picture by Isabel de María de Gaztañondo

On the other hand, the term ‘dementia’ denotes a syndrome acquired, produced by an organic cause, characterised by an ensemble of signs and symptoms that produce a persistent cognitive decline and that alter the functional capacity of the person with absence of alteration of the conscience. There are a lot of ilnesses caused by dementia and Alzheimer -doctor homonym that  described it for the first time more than a 100 years ago- is widely the most common (Desai i Grossberg, 2005; Kalaria et al., 2008).
Furthermore, the project developed the eponymous (SMART4MD) digital platform including an application which was specifically designed for people with MCI or mild dementia, their informal carers, and healthcare professionals. The SMART4MD app, pre-installed at 7 inch tablets, is available in 5 different languages: English, Spanish, Czech, Swedish and French.
SMART4MD application has been developed with 7 core functionalities: 1. My reminders (for medicines, appointments and general tasks); 2. My health (with multiple symptoms tracking); 3. People I know; 4. Games & Resources (with cognitive games and interesting news); 5. About Dementia; 6. Personalize my app (with options to increase size of text, volume, disable functionalities, change colours etc.); and 7. Share with others (e.g. carers and healthcare professionals). The application itself is highly customizable based on the conditions and preferences of each users and is developed to be used by both people with MCI or dementia, their personal carers, and also by their healthcare professionals.

SMART4MD app functionalities


SMART4MD platform and its objectives are currently being tested through a large scale randomized controlled clinical trial with more than 1000 dyads including both people with MCI or dementia and their informal carers.

A feasibility study was done and the 18-month trial of the SMART4MD platform is currently running to test several research hypotheses providing basis for further exploitation of the SMART4MD platform in EU territories. More than 1000 dyads (people with MCI or dementia and their carer) were recruited to either the intervention group (with the platform) or control group (receiving usual care). Regular 6-month visits at health centres are providing data on quality of life by using QoL-AD [1], MMSE cognitive function [2], EQ-5D functional decline [3], medication (dose and pill counts) and appointments adherence combined with data gathered from the application on user behaviour.

Currently, a 6-month data collection across more than 1000 people with MCI or mild dementia with an average age of 74 years, their starting average MMSE score of 25,5 points and GDS-15 at 3 points, shows a slight increase of MMSE score among the intervention group as compared to control group and average MMSE year-to-year decrease. It also points the most frequently used functions of the SMART4MD application being My Reminders, MyHealth and Games & Resources.


[1] Quality of Life-AD -Qol-AD- (Logsdon et al, 2002).The quality of life of a person with dementia is the main measure of the result of the essay. It will be assessed by the total score of the Qol-AD scale. The patients with dementia will experience cognitive decrease during the course of the research (2 years), and even hampering them to complete the scale. That is why the carer also will complete the scale, in parallel and on behalf of the participant since the onset of the research. The tool has been designed specifically to assess the quality of life of individuals with dementia considering the point of view of the patient and the carer.
The scale comprises 13 elements, including the appraisal of the relation of the participant with friends and relatives, the financial situation, physical condition, state of mind and general quality of the appraisal of the life.

[2] Mini-Mental State Examination -MMSE- (Folstein et al, 1975). Consists on a cognitive test, looking for the evaluation of the short term memory. Participants must have a MMSE average among 20-28 points.
[3] EuroQol 5D scale used to evaluate the quality of life of people with dementia. This scale it is a standardized tool to analize the cost of living for people with dementia (Guyatt et al, 1993; Amb el grup EuroQol, 1996). It is a self managed scaled featuring 5 qustions including mobility, hygiene, physical activity, pain or anxiety. (Thorgrimsen et al, 2003).
  • Brooks, R., with the EuroQol Group, (1996). EuroQol: the current state of play. Health Policy 37, pp. 53-72.
  • Desai, A. K. y Grossberg, G. T. (2005). Diagnosis and treatment of Alzheimer’s disease. Neurology, 64(12 Suppl 3), 34-39.
  • Flicker, C., Ferris, S. H. y Reisberg, B. (1991). Mild Cognitive Impairment in the elderly: Predictors of dementia. Neurology, 41(7), 1006- 1009.
  • Folstein, M.F., Folstein, S.E. and McHugh, P.R., (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), pp.189-198.
  • Ganguli, M., Chang, C. C., Snitz, B. E., Saxton, J. A., Vanderbilt, J. y Lee, C. W. (2010). Prevalence of Mild Cognitive Impairment by multiple classifications: The Monongahela- Youghiogheny healthy aging team (MYHAT) project. The American Journal of Geriatric Psychiatry, 18(8), 674-683.
  • Guyatt, G-H., Feeny, D-H., Patrick, D-L. (1993). Measuring Health-Related Quality of Life. Intern Medicin 118 (8), pp.622-629.
  • Kalaria, R. N., Maestre, G. E., Arizaga, R., Friedland, R. P., Galasko, D., Hall, K., et al. (2008). Alzheimer’s disease and vascular dementia in developing countries: Prevalence, management, and risk factors. The Lancet Neurology, 7(9), 812-826.
  • Logsdon, R.G., Gibbons, L.E., McCurry, S.M., Teri, L., (2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic medicine 64 (3), pp.510–519.
  • Lopez, O. L., Jagust, W. J., DeKosky, S. T., Becker, J. T., Fitzpatrick, A., Dulberg, C., et al. (2003). Prevalence and classification of Mild Cognitive Impairment in the cardiovascular health study cognition study: Part 1. Archives of Neurology, 60(10), 1385-1389.
  • Thorgrimsen, L., Selwood, A., Spector, A., Royan, L., de Madariaga Lopez, M., Woods, R.T. and Orrell, M., (2003). Whose quality of life is it anyway?: The validity and reliability of the Quality of Life-Alzheimer’s Disease (QoL-AD) scale. Alzheimer Disease & Associated Disorders, 17(4), pp.201-208.



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