The CAREPATH Study for Personalized Management of Multimorbidity in Elderly with Mild Cognitive Impairment and Mild Dementia
Main Article Content
Abstract
Introduction: Multimorbidity is prevalent among older adults and is associated with cognitive impairment and dementia, increasing the need for innovative care solutions. The CAREPATH project, funded by the European Commission Horizon 2020 program, has developed an integrated care platform tailored to older adults with multimorbidity, particularly those with mild cognitive impairment or mild dementia. This platform aims to enhance screening, optimize personalized treatment, and support multidisciplinary care, aligning with the European Society of Medicine's policy framework for managing neurodegenerative diseases.
Methods: This paper describes the methodology for implementing an integrated care platform focused on managing mild cognitive impairment and mild dementia. CAREPATH architecture supports multidisciplinary care teams in creating personalized treatment plans based on evidence-based guidelines, involving patients and their caregivers. The platform for healthcare professionals features modular disease pages for comprehensive care, including dedicated sections for screening complications and delivering non-pharmacological interventions such as nutrition, lifestyle, and physical exercise recommendations.
Results: The CAREPATH platform has been fully implemented from a technical perspective, with the next step being the clinical investigation to evaluate its efficacy in improving health-related quality-of-life for older adults with mild cognitive impairment or mild dementia and its cost-effectiveness. This study will be conducted in two phases: a technical validation and usability study, followed by a clinical investigation (randomized clinical trial) across four European centers in Spain, Germany, the United Kingdom and Romania. Preliminary tests, including functional, integration, and laboratory system testing, have been conducted to ensure the platform's readiness, with most technical issues resolved. The TVU phase is scheduled to begin in September 2024.
Keywords:
integrated care, personalized care, multimorbidity, mild dementia, mild cognitive impairment
Article Details
How to Cite
ERTURKMEN, Gokce B. Laleci et al.
The CAREPATH Study for Personalized Management of Multimorbidity in Elderly with Mild Cognitive Impairment and Mild Dementia.
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5626>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5626.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Salive, M. E. (2013). Multimorbidity in older adults. Epidemiologic reviews, 35(1), 75-83. https://doi.org/10.1093/epirev/mxs009
2. Chen, H., Zhou, Y., Huang, L., Xu, X., & Yuan, C. (2023). Multimorbidity burden and developmental trajectory in relation to later‐life dementia: a prospective study. Alzheimer's & Dementia, 19(5), 2024-2033. https://doi.org/10.1002/ALZ.12840
3. Grande, G., Marengoni, A., Vetrano, D. L., Roso‐Llorach, A., Rizzuto, D., Zucchelli, A., ... & Calderón‐Larrañaga, A. (2021). Multimorbidity burden and dementia risk in older adults: the role of inflammation and genetics. Alzheimer's & Dementia, 17(5), 768-776. https://doi.org/10.1002/ALZ.12237
4. Wei, M. Y., Levine, D. A., Zahodne, L. B., Kabeto, M. U., & Langa, K. M. (2020). Multimorbidity and cognitive decline over 14 years in older Americans. The Journals of Gerontology: Series A, 75(6), 1206-1213. https://doi.org/10.1093/GERONA/GLZ147
5. Vassilaki, M., Aakre, J. A., Cha, R. H., Kremers, W. K., St. Sauver, J. L., Mielke, M. M., ... & Roberts, R. O. (2015). Multimorbidity and risk of mild cognitive impairment. Journal of the American Geriatrics Society, 63(9), 1783-1790. https://doi.org/10.1111/jgs.13612
6. Zhang, J., Xu, X., Yang, L., & Wang, J. (2021). Met and unmet care needs of home‐living people with dementia in China: an observational study using the Camberwell Assessment of Need for the Elderly. Geriatrics & Gerontology International, 21(1), 102-107. https://doi.org/10.1111/ggi.14093
7. European Society of Medicine. (2024). Policy Framework: Reducing The Burden Of Neurodegenerative Diseases In Europe And Beyond. https://archive.org/details/policy-framework-reducing-the-burden-of-neurodegenerative-diseases-in-europe-and-beyond
8. Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019). Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC medicine, 17, 1-13. https://doi.org/10.1186/s12916-019-1369-7
9. García-García-Patino, R., Benito-León, J., Mitchell, A. J., Pastorino-Mellado, D., García García, R., Ladera-Fernández, V., ... & Cacho, J. (2020). Memory and executive dysfunction predict complex activities of daily living impairment in amnestic multi-domain mild cognitive impairment. Journal of Alzheimer's Disease, 75(3), 1061-1069. https://doi.org/10.3233/JAD-191263
10. Ginsberg, T. B., Powell, L., Emrani, S., Wasserman, V., Higgins, S., Chopra, A., ... & Libon, D. J. (2019). Instrumental activities of daily living, neuropsychiatric symptoms, and neuropsychological impairment in mild cognitive impairment. Journal of Osteopathic Medicine, 119(2), 96-101. https://doi.org/10.7556/jaoa.2019.015
11. Welsh, T. J. (2019). Multimorbidity in people living with dementia. Case reports in women's health, 23, e00125. https://doi.org/10.1016/j.crwh.2019.e00125
12. Pournik, O., Ahmad, B., Lim Choi Keung, S. N., Khan, O., Despotou, G., Consoli, A., ... & Arvanitis, T. N. (2022). CAREPATH: developing digital integrated care solutions for multimorbid patients with dementia. In Advances in Informatics, Management and Technology in Healthcare (pp. 487-490). IOS Press. https://doi.org/10.3233/SHTI220771
13. Gencturk, M., Laleci Erturkmen, G. B., Akpinar, A. E., Pournik, O., Ahmad, B., Arvanitis, T. N., ... & Abizanda, P. (2024). Transforming evidence-based clinical guidelines into implementable clinical decision support services: the CAREPATH study for multimorbidity management. Frontiers in Medicine, 11, 1386689. https://doi.org/10.3389/fmed.2024.1386689
14. Gappa, H., Mohamad, Y., Breidenbach, M., Abizanda, P., Schmidt-Barzynski, W., Steinhoff, A., ... & Velasco, C. A. (2022, July). Making Person-Centred Health Care Beneficial for People with Mild Cognitive Impairment (MCI) or Mild Dementia–Results of Interviews with Patients and Their Informal Caregivers. In International Conference on Computers Helping People with Special Needs (pp. 468-474). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-08648-9_54
15. Mohamad, Y., Gappa, H., Heiba, N., Yuksel, M., Velasco, C. A., Gencturk, M., ... & Schmidt-Barzynski, W. (2022, August). Key scenarios, Use Cases & Architecture of an E-health Homecare Instance. In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 25-30). https://doi.org/10.1145/3563137.3563160
16. Pournik, O., Ahmad, B., Lim Choi Keung, S. N., Peake, A., Rafid, S., Tong, C., ... & Arvanitis, T. N. (2023). Interoperable E-Health System Using Structural and Semantic Interoperability Approaches in CAREPATH. In Healthcare transformation with informatics and artificial intelligence (pp. 608-611). IOS Press. https://doi.org/10.3233/SHTI230571
17. Gencturk, M., Laleci Erturkmen, G. B., Gappa, H., Schmidt-Barzynski, W., Steinhoff, A., Abizanda, P., ... & Yuksel, M. (2022, August). The design of a mobile platform providing personalized assistance to older multimorbid patients with mild dementia or mild cognitive impairment (MCI). In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 37-43). https://doi.org/10.1145/3563137.3563138
18. Robbins, T. D., Muthalagappan, D., O’Connell, B., Bhullar, J., Hunt, L. J., Kyrou, I., ... & Randeva, H. (2022, August). Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions. In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 1-6). https://doi.org/10.1145/3563137.3563182
19. Dans, A. L., & Dans, L. F. (2010). Appraising a tool for guideline appraisal (the AGREE II instrument). Journal of clinical epidemiology, 63(12), 1281-1282. https://doi.org/10.1016/j.jclinepi.2010.06.005
20. Hughes, C. P., Berg, L., Danziger, W., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British journal of psychiatry, 140(6), 566-572. https://doi.org/10.1192/bjp.140.6.566
21. Cummings, J. (2020). The neuropsychiatric inventory: development and applications. Journal of geriatric psychiatry and neurology, 33(2), 73-84. https://doi.org/10.1177/0891988719882102
22. Ismail, Z., Agüera-Ortiz, L., Brodaty, H., Cieslak, A., Cummings, J., Fischer, C. E., ... & Lyketsos, C. (2017). The Mild Behavioral Impairment Checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. Journal of Alzheimer's disease, 56(3), 929-938. https://doi.org/10.3233/JAD-160979
23. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
24. Ismail, Z., Black, S. E., Camicioli, R., Chertkow, H., Herrmann, N., Laforce Jr, R., ... & CCCDTD5 participants. (2020). Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia. Alzheimer's & Dementia, 16(8), 1182-1195. https://doi.org/10.1002/alz.12105
25. World Health Organization. (2019). mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP) - Version 2.0. https://www.who.int/publications/i/item/9789241549790
26. Rubenstein, L. Z., Harker, J. O., Salvà, A., Guigoz, Y., & Vellas, B. (2001). Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(6), M366-M372. https://doi.org/10.1093/gerona/56.6.M366
27. Casas‐Herrero, Á., Saez de Asteasu, M. L., Antón‐Rodrigo, I., Sánchez‐Sánchez, J. L., Montero‐Odasso, M., Marín‐Epelde, I., ... & Izquierdo, M. (2022). Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial. Journal of cachexia, sarcopenia and muscle, 13(2), 884-893. https://doi.org/10.1002/jcsm.12925
28. de Fátima Ribeiro Silva, C., Ohara, D. G., Matos, A. P., Pinto, A. C. P. N., & Pegorari, M. S. (2021). Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. International journal of environmental research and public health, 18(20), 10612. https://doi.org/10.3390/ijerph182010612
29. Joddrell, P., & Astell, A. J. (2016). Studies involving people with dementia and touchscreen technology: a literature review. JMIR rehabilitation and assistive technologies, 3(2), e5788. https://doi.org/10.2196/rehab.5788
30. Kerkhof, Y. J. F., Bergsma, A., Graff, M. J. L., & Dröes, R. M. (2017). Selecting apps for people with mild dementia: identifying user requirements for apps enabling meaningful activities and self-management. Journal of rehabilitation and assistive technologies engineering, 4, 2055668317710593. https://doi.org/10.1177/2055668317710593
31. Lim, F. S., Wallace, T., Luszcz, M. A., & Reynolds, K. J. (2013). Usability of tablet computers by people with early-stage dementia. Gerontology, 59(2), 174-182. https://doi.org/10.1159/000343986
32. Pang, G. K. H., & Kwong, E. (2015, January). Considerations and design on apps for elderly with mild-to-moderate dementia. In 2015 International Conference on Information Networking (ICOIN) (pp. 348-353). IEEE. https://doi.org/10.1109/ICOIN.2015.7057910
33. Ancient, C., & Good, A. (2013). Issues with designing dementia-friendly interfaces. In HCI International 2013-Posters’ Extended Abstracts: International Conference, HCI International 2013, Las Vegas, NV, USA, July 21-26, 2013, Proceedings, Part I 15 (pp. 192-196). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-39473-7_39
34. Eurostat (2024). Demography of Europe – 2024 edition. https://ec.europa.eu/eurostat/web/interactive-publications/demography-2024
2. Chen, H., Zhou, Y., Huang, L., Xu, X., & Yuan, C. (2023). Multimorbidity burden and developmental trajectory in relation to later‐life dementia: a prospective study. Alzheimer's & Dementia, 19(5), 2024-2033. https://doi.org/10.1002/ALZ.12840
3. Grande, G., Marengoni, A., Vetrano, D. L., Roso‐Llorach, A., Rizzuto, D., Zucchelli, A., ... & Calderón‐Larrañaga, A. (2021). Multimorbidity burden and dementia risk in older adults: the role of inflammation and genetics. Alzheimer's & Dementia, 17(5), 768-776. https://doi.org/10.1002/ALZ.12237
4. Wei, M. Y., Levine, D. A., Zahodne, L. B., Kabeto, M. U., & Langa, K. M. (2020). Multimorbidity and cognitive decline over 14 years in older Americans. The Journals of Gerontology: Series A, 75(6), 1206-1213. https://doi.org/10.1093/GERONA/GLZ147
5. Vassilaki, M., Aakre, J. A., Cha, R. H., Kremers, W. K., St. Sauver, J. L., Mielke, M. M., ... & Roberts, R. O. (2015). Multimorbidity and risk of mild cognitive impairment. Journal of the American Geriatrics Society, 63(9), 1783-1790. https://doi.org/10.1111/jgs.13612
6. Zhang, J., Xu, X., Yang, L., & Wang, J. (2021). Met and unmet care needs of home‐living people with dementia in China: an observational study using the Camberwell Assessment of Need for the Elderly. Geriatrics & Gerontology International, 21(1), 102-107. https://doi.org/10.1111/ggi.14093
7. European Society of Medicine. (2024). Policy Framework: Reducing The Burden Of Neurodegenerative Diseases In Europe And Beyond. https://archive.org/details/policy-framework-reducing-the-burden-of-neurodegenerative-diseases-in-europe-and-beyond
8. Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019). Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC medicine, 17, 1-13. https://doi.org/10.1186/s12916-019-1369-7
9. García-García-Patino, R., Benito-León, J., Mitchell, A. J., Pastorino-Mellado, D., García García, R., Ladera-Fernández, V., ... & Cacho, J. (2020). Memory and executive dysfunction predict complex activities of daily living impairment in amnestic multi-domain mild cognitive impairment. Journal of Alzheimer's Disease, 75(3), 1061-1069. https://doi.org/10.3233/JAD-191263
10. Ginsberg, T. B., Powell, L., Emrani, S., Wasserman, V., Higgins, S., Chopra, A., ... & Libon, D. J. (2019). Instrumental activities of daily living, neuropsychiatric symptoms, and neuropsychological impairment in mild cognitive impairment. Journal of Osteopathic Medicine, 119(2), 96-101. https://doi.org/10.7556/jaoa.2019.015
11. Welsh, T. J. (2019). Multimorbidity in people living with dementia. Case reports in women's health, 23, e00125. https://doi.org/10.1016/j.crwh.2019.e00125
12. Pournik, O., Ahmad, B., Lim Choi Keung, S. N., Khan, O., Despotou, G., Consoli, A., ... & Arvanitis, T. N. (2022). CAREPATH: developing digital integrated care solutions for multimorbid patients with dementia. In Advances in Informatics, Management and Technology in Healthcare (pp. 487-490). IOS Press. https://doi.org/10.3233/SHTI220771
13. Gencturk, M., Laleci Erturkmen, G. B., Akpinar, A. E., Pournik, O., Ahmad, B., Arvanitis, T. N., ... & Abizanda, P. (2024). Transforming evidence-based clinical guidelines into implementable clinical decision support services: the CAREPATH study for multimorbidity management. Frontiers in Medicine, 11, 1386689. https://doi.org/10.3389/fmed.2024.1386689
14. Gappa, H., Mohamad, Y., Breidenbach, M., Abizanda, P., Schmidt-Barzynski, W., Steinhoff, A., ... & Velasco, C. A. (2022, July). Making Person-Centred Health Care Beneficial for People with Mild Cognitive Impairment (MCI) or Mild Dementia–Results of Interviews with Patients and Their Informal Caregivers. In International Conference on Computers Helping People with Special Needs (pp. 468-474). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-08648-9_54
15. Mohamad, Y., Gappa, H., Heiba, N., Yuksel, M., Velasco, C. A., Gencturk, M., ... & Schmidt-Barzynski, W. (2022, August). Key scenarios, Use Cases & Architecture of an E-health Homecare Instance. In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 25-30). https://doi.org/10.1145/3563137.3563160
16. Pournik, O., Ahmad, B., Lim Choi Keung, S. N., Peake, A., Rafid, S., Tong, C., ... & Arvanitis, T. N. (2023). Interoperable E-Health System Using Structural and Semantic Interoperability Approaches in CAREPATH. In Healthcare transformation with informatics and artificial intelligence (pp. 608-611). IOS Press. https://doi.org/10.3233/SHTI230571
17. Gencturk, M., Laleci Erturkmen, G. B., Gappa, H., Schmidt-Barzynski, W., Steinhoff, A., Abizanda, P., ... & Yuksel, M. (2022, August). The design of a mobile platform providing personalized assistance to older multimorbid patients with mild dementia or mild cognitive impairment (MCI). In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 37-43). https://doi.org/10.1145/3563137.3563138
18. Robbins, T. D., Muthalagappan, D., O’Connell, B., Bhullar, J., Hunt, L. J., Kyrou, I., ... & Randeva, H. (2022, August). Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions. In Proceedings of the 10th International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (pp. 1-6). https://doi.org/10.1145/3563137.3563182
19. Dans, A. L., & Dans, L. F. (2010). Appraising a tool for guideline appraisal (the AGREE II instrument). Journal of clinical epidemiology, 63(12), 1281-1282. https://doi.org/10.1016/j.jclinepi.2010.06.005
20. Hughes, C. P., Berg, L., Danziger, W., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British journal of psychiatry, 140(6), 566-572. https://doi.org/10.1192/bjp.140.6.566
21. Cummings, J. (2020). The neuropsychiatric inventory: development and applications. Journal of geriatric psychiatry and neurology, 33(2), 73-84. https://doi.org/10.1177/0891988719882102
22. Ismail, Z., Agüera-Ortiz, L., Brodaty, H., Cieslak, A., Cummings, J., Fischer, C. E., ... & Lyketsos, C. (2017). The Mild Behavioral Impairment Checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. Journal of Alzheimer's disease, 56(3), 929-938. https://doi.org/10.3233/JAD-160979
23. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
24. Ismail, Z., Black, S. E., Camicioli, R., Chertkow, H., Herrmann, N., Laforce Jr, R., ... & CCCDTD5 participants. (2020). Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia. Alzheimer's & Dementia, 16(8), 1182-1195. https://doi.org/10.1002/alz.12105
25. World Health Organization. (2019). mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP) - Version 2.0. https://www.who.int/publications/i/item/9789241549790
26. Rubenstein, L. Z., Harker, J. O., Salvà, A., Guigoz, Y., & Vellas, B. (2001). Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(6), M366-M372. https://doi.org/10.1093/gerona/56.6.M366
27. Casas‐Herrero, Á., Saez de Asteasu, M. L., Antón‐Rodrigo, I., Sánchez‐Sánchez, J. L., Montero‐Odasso, M., Marín‐Epelde, I., ... & Izquierdo, M. (2022). Effects of Vivifrail multicomponent intervention on functional capacity: a multicentre, randomized controlled trial. Journal of cachexia, sarcopenia and muscle, 13(2), 884-893. https://doi.org/10.1002/jcsm.12925
28. de Fátima Ribeiro Silva, C., Ohara, D. G., Matos, A. P., Pinto, A. C. P. N., & Pegorari, M. S. (2021). Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. International journal of environmental research and public health, 18(20), 10612. https://doi.org/10.3390/ijerph182010612
29. Joddrell, P., & Astell, A. J. (2016). Studies involving people with dementia and touchscreen technology: a literature review. JMIR rehabilitation and assistive technologies, 3(2), e5788. https://doi.org/10.2196/rehab.5788
30. Kerkhof, Y. J. F., Bergsma, A., Graff, M. J. L., & Dröes, R. M. (2017). Selecting apps for people with mild dementia: identifying user requirements for apps enabling meaningful activities and self-management. Journal of rehabilitation and assistive technologies engineering, 4, 2055668317710593. https://doi.org/10.1177/2055668317710593
31. Lim, F. S., Wallace, T., Luszcz, M. A., & Reynolds, K. J. (2013). Usability of tablet computers by people with early-stage dementia. Gerontology, 59(2), 174-182. https://doi.org/10.1159/000343986
32. Pang, G. K. H., & Kwong, E. (2015, January). Considerations and design on apps for elderly with mild-to-moderate dementia. In 2015 International Conference on Information Networking (ICOIN) (pp. 348-353). IEEE. https://doi.org/10.1109/ICOIN.2015.7057910
33. Ancient, C., & Good, A. (2013). Issues with designing dementia-friendly interfaces. In HCI International 2013-Posters’ Extended Abstracts: International Conference, HCI International 2013, Las Vegas, NV, USA, July 21-26, 2013, Proceedings, Part I 15 (pp. 192-196). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-39473-7_39
34. Eurostat (2024). Demography of Europe – 2024 edition. https://ec.europa.eu/eurostat/web/interactive-publications/demography-2024