MYCO CONCEPT:

Caregiver's are expected, without knowledge or expertise, to manage a transitional period in loved one's life. Myco is a VUI app that supports them in this new role. By gathering data and providing synthesized reports, Myco helps the caregiver with decision making, doctor visits, increasing care responsibilities, and how to let family members know that it is time to act.

MYCO Value Propositions:

• For the Caregiver: Myco offers peace of mind and less of a "roller coaster experience," by detecting small changes and processing them for  evidence of larger trends that signal what is around the corner.
• For the Healthcare Provider: Myco provides evidence needed to justify further testing, and can act as longitudinal testing needed for a diagnosis. 
• For the Bio Staticians/Scientists: Myco allows users to opt-into sharing their data critical to better understand the pre-clinical aspects, and focus on prevention strategies or treatments. 
• For the Care-Recipient: Myco is simple brain tests that anyone can take to quantify their self and cognition. Myco can help them prove that they can take care of themselves, or help them to accept and face the facts that they can't. 

MYCO Details

Early Intervention

It is hard to pin point early signs of mild cognitive impairment, the precursor to various forms of dementia. It can be 2 years of depression and anxiety before any clinical prognosis of dementia occurs, usually because a loved one has noticed some changes in memory. When this does get noticed, it is likely to be at a later stage, and require immediate intervention and care. All of a sudden, lives are upended. The earliest phase is the best time to start their new role as a caregiver.  With a more smooth and gradual transition into caregiving, they can get used to the role, and prepare for the future changes with the participation and help of the care-recipient. Too often this time is lost because of late detection or denial.

Direction: What and When

The categories that are linked to the score and presented in the report are based off ADLs and IADLs, because geriatricians assess ADLs and IADLs as part of assessing an older person’s “function.” Generally, older adults need to be able to manage ADLs and IADLs in order to live independently without the assistance of another person.

Instrumental Activities of Daily Living (IADLs): These are the self-care tasks which require more complex thinking skills, including organizational skills. 

Activities of Daily Living (ADLs): These are the basic self-care tasks that we initially learn as very young children. 

The report detects changes and scores them, assigning a color code to the categories of IADLs and ADLs, so that the caregiver can quickly see if an area is threatened or not. If the financial planning category is in yellow, the caregiver knows that (warning!) it may be time to start thinking about it talking to the bank. 

Easy Integration

• Voice-enabled smart speakers to reach 55% of U.S. households by 2022, says report. Combined with smartphones and smart speakers, the report forecasts the total number of voice assistant devices will reach 870 million in the U.S. by 2022 (TechCrunch) 
• This solution ties into current quantified-self and data-tracking consumer trends (such as Fitbits.)
• As people become more used to conversations with VUIs, the increase in interaction with the VUI means more accurate readings on their verbal cognition, and more advanced detection. 
• The cost of the app could be mitigated by the value derived from the data provided by participants, and outside research funding.

Emotional Well-being

For the care-giver, the functionality of the VUI emphasizes the value and importance of team work at every possible moment. The easy-to-share buttons and prompts are to remind the caregiver to ask for help, to share the burden, to let those offering help figure out themselves, if possible, how they can do it, simply by reviewing the report. Sometimes when asked "how can I help" the caregiver is too occupied, busy, or stressed, to think clearly. The report does that for them, and makes team-decisions easier to make with concrete information to center a discussion around. 

For the care-recipient it is easier to confess concerns, fears, and forgetfulness to an app, rather than to a child, spouse, or friend. This circumnavigates the problematic area of role-reversal. The VUI personality acts as an intermediary step from self-care to shared-care, paving the way for a caregiver to assume new responsibilities. In the earliest stages, the reports feel like much-needed directions, when you don't know where to turn, or what to do. 

Cognitive Testing

Most of the test that are approved for cognitive testing can be done quite simply by the physician. Some options are presented in the cognitive testing toolkit from the Alzheimer's Association, and are designed for clinical use during a yearly exam. But such testing can be more reliably conducted, via voice, in a familiar environment, when patients are relaxed, and the data can be calibrated over time and repeated tests. The voice assistant is already recording speech, and analyzing it. The framework of Myco would be to turn that into data reports that tracks cognitive status over time. 

"Speech sampling and analysis is by definition evaluating the cognitive domain of language (as opposed to problem solving or memory). To date it has been most effective in distinguishing controls from individuals with dementia. " 

Nick Bott, Research Scientist at Stanford School of Medicine

Specific tests performed by Myco include variations that are similar to classic games such as Scattegories and concentration. 

• One-minute naming test/Verbal fluency test
• Three Word Recall
• Abstraction (similarity between X and Y) 

Experiments & Refinements

First user journey: Google document of feedback here

Second user journey: Google document of feedback here

Prototype Report (see below): Google document of feedback here

Benefits + VALUE 

(Quotes from caregiver feedback)

"Wow. It provides an absolutely neutral set of information based on neutral expertise.  In other words, it removes the "personal" from the decision.  You're not making a decision based on your best hunch, and you can fall back on the data to provide you confidence."

"It's like a second helper."

"With this information; It would give me something that would help me talk with relatives about how we could combine forces to help my gran get around."

This would help keep a clear record of daily progression, as a caregiver you are dealing with a lot so this would be helpful."

"It would be a less intrusive way to make decisions. My mother has to accompany my grandmother to all appointments to get the true story, having an app that tracks this would be beneficial over time. Less emotional, more facts-based. Something she could share with her siblings (they live far away)"

"I would use this app to better communicate with the PLWD's doctor on what their abilities and needs are as well as to better formulate my own questions before making decisions."

References:

• https://techcrunch.com/2017/11/08/voice-enabled-smart-speakers-to-reach-55-of-u-s-households-by-2022-says-report/
• https://www.washingtontimes.com/news/2017/dec/7/15-million-americans-will-have-alzheimers-or-other/
• https://www.researchgate.net/publication/309843235_A_Prototype_for_Alzheimer%27s_Disease_Early_Diagnosis_to_Assist_Caregivers_and_Physicians
• https://asourparentsage.net/2009/12/17/adls-and-iadls-whats-the-difference/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140653
• http://www.jabfm.org/content/25/3/367.long#T1
• https://www.alz.org/documents_custom/141209-CognitiveAssessmentToo-kit-final.pdf