REVIEW OF: Scullin MK et al, J Am Geriatr Soc 2022;70(2):459–469

STUDY TYPE: Randomized parallel group trial

Can simple smartphone apps improve cognition in the elderly? While a Cochrane review found no high-quality studies showing a benefit of such technology for people with dementia (Van der Roest HG et al, Cochrane Database Syst Rev 2017;6(6):CD009627), the current study focused on people with milder cognitive impairment. Researchers were interested in evaluating prospective memory (PM): remembering to do things you’ve planned to do. A decline in PM is often an early marker of Alzheimer’s disease and leads to forgetting to take meds, pay bills, or attend appointments.

For this study, the authors recruited 52 older adults with an average age of 75 years, recently diagnosed with mild cognitive impairment (MCI) or mild dementia but independent in their activities of daily living. Participants were mostly White with an average of 14 years of education. The researchers randomly assigned participants to use one of two smartphone apps for four weeks: 1) a reminder app (Cortana) or 2) a digital recording app (Voice Recorder for Android or Voice Memos for iPhone). Participants were taught how to use the apps to make their own reminders. They were then assigned PM tasks to complete on scheduled days and in certain locations. The researchers tested the participants’ memory before and after the study using interviews and individualized memory tasks, like remembering to make a phone call on certain days. Ninety percent of participants completed the study.

The results were encouraging. Regardless of which app was used, participants performed better than expected on memory tasks. They completed PM tasks about 52% of the time, compared to a 20% expected task completion rate reported in prior similar studies. Two-thirds of participants also reported clinically significant improvements on both the Prospective-Retrospective Memory Questionnaire and a structured interview, which assessed performance on common daily activities requiring PM (such as remembering to take medications).

CARLAT TAKE

This methodologically rigorous study provides preliminary evidence that apps, especially reminder apps, may improve performance on PM tasks in MCI and mild dementia. It’s important to note that the participants were mostly White and highly educated, so their experience using a new technology is not generalizable to other populations. Still, it’s reassuring to see that participants with cognitive impairment can learn new technologies with the right support. Given the short study duration of four weeks, it’s still unclear whether the benefits of app use on PM tasks can be sustained. As with all new skills, patients may benefit from the thoughtful use of reminders and booster sessions.