New Opportunities for the Early Detection and Treatment of Cognitive Decline: Adherence Challenges and the Promise of Smart and Person-Centered Technologies.

Early detection of age-related cognitive decline has transformative potential to advance the scientific understanding of cognitive impairments and possible treatments by identifying relevant participants for clinical trials. Furthermore, early detection is also key to early intervention once effective treatments have been developed. Novel approaches to the early detection of cognitive decline, for example through assessments administered via mobile apps, may require frequent home testing which can present adherence challenges. And, once decline has been detected, treatment might require frequent engagement with behavioral and/or lifestyle interventions (e.g., cognitive training), which present their own challenges with respect to adherence. We discuss state-of-the-art approaches to the early detection and treatment of cognitive decline, adherence challenges associated with these approaches, and the promise of smart and person-centered technologies to tackle adherence challenges. Specifically, we highlight prior and ongoing work conducted as part of the Adherence Promotion with Person-centered Technology (APPT) project, and how completed work will contribute to the design and development of a just-in-time, tailored, smart reminder system that infers participants' contexts and motivations, and how ongoing work might build toward a reminder system that incorporates dynamic machine learning algorithms capable of predicting and preventing adherence lapses before they happen. APPT activities and findings will have implications not just for cognitive assessment and training, but for technology-mediated adherence-support systems to facilitate physical exercise, nutrition, medication management, telehealth, and social connectivity, with the potential to broadly improve the engagement, health, and well-being of older adults.