Abstract: “I got training on the brain”: Designing Messages to Improve Seniors’ Adherence to Cognitive Assessment and Training Programs

◆ Mia Liza A. Lustria, Florida State University
◆ Michael Dieciuc, Florida State University
◆ Andrew Dilanchian, Florida State University
◆ Shenghao Zhang, Florida State University
◆ Walter Boot, Florida State University
◆ Neil Charness, Florida State University
◆ Dawn Carr, Florida State University
◆ Zhe He, Florida State University
◆ Shayok Chakraborty, Florida State University
◆ Antonio Terracciano, Florida State University

By 2030, Americans born between 1946 to 1964 will be 65 or older, thus, significantly increasing the disease burden for neurodegenerative disorders such as dementia and Alzheimer’s disease. This has spurred an increased interest in finding strategies that can help maintain or improve older adults’ brain health, as well as delay non-normative changes in cognition. Unfortunately, non-normative declines often go unnoticed until an individual starts to experience difficulties in daily functioning (Crous-Bou et al., 2017). Novel administration methods involving repeated testing may be especially sensitive to cognitive decline (Sliwinski et al., 2018). Once detected, research suggests early intervention is key to combat decline. Non-pharmacologic interventions such as the use of self-administered cognitive training and assessment programs hold promise for promoting healthy cognitive aging and for facilitating early detection of abnormal cognitive changes (Butler et al., 2017; Gavelin et al., 2020; ten Brinke et al., 2017). Engaging in regular brain training exercises has the potential to improve overall cognitive performance of older adults and reverse declines in cognition (ten Brinke et al., 2017). To be effective, however, participants are required to engage in cognitive assessments and brain training programs over extended periods of time. Unfortunately, research has shown that promoting adherence to such interventions has been challenging. The Adherence Promotion with Person-Centered Technology (APPT) project is a multidisciplinary effort aimed at facilitating early detection and early intervention of cognitive decline through the development of an adaptive system to improve adherence to self-administered cognitive training and assessments. The system uses artificial intelligence to send tailored text reminders to participants at times when they are most likely to prevent non-adherence. These notifications are tailored according to participants’ preferences, successful engagement behavior, and other forms of information. Currently in the development phase, we conducted a pilot of the smart reminder system (n=40, older adults aged 65+) to test the feasibility of the messaging system and gain insight into older adults’ perceptions of different variants of motivational messages. Participants were required to engage in ten days of tablet gaming using the Mind Frontiers application . During these ten days, participants received motivational messages alternating between their highest and lowest chosen motivational categories and were asked to rate them. Posttest interviews revealed two things. One, participants expressed a general aversion towards figuratively framed motivational messages focused mostly on gameplay performance, and largely indicated that the messages felt inappropriate or condescending in tone. Participants were, however, more receptive toward messages that were formally framed and that had tangible, realistic goals to strive for. Two, the external motivations emphasized in the messages did not influence behavior above and beyond what participants indicated were their personal motivations for completing the study. This could be due to the 10-day duration of the study being too short for non-adherence to be a serious challenge. These preliminary findings have implications for designing messages to improve older adults’ adherence to cognitive assessments and brain training. This project is supported by NIA R01 AG064529.