Project idea: Mirrorneurons Induced Motion Enhancement for elderly people with dementia.

In this project we argue that cognition and behavior will benefit from watching people doing specific actions: people who walk, people who do the laundry, people who are preparing meals and people who eat. In the present project we will invite in an implicit way older persons with dementia who are still ambulatory but hardly walk during the day, to watch older people who are walking and doing household chores. To obtain this goal, we will project on the wall or the television of the room they are sitting during the day, daily situations in which older people are walking and doing household chores. We expect that this projection will stimulate the mirror neurons of these patients by which they will start walking again by themselves. The VU university of Amsterdam will assist with the design of the project and monitoring of results.

We also will provide intuitive guidance for these people to the location where the projected activities are being performed. For this we will use Design for Interaction techniques, assisted by the Technical University of Delft.

To enable elderly persons with dementia to move around as freely as possible and still monitor there safety and the amount of movement/exercise they have, we must use and improve existing sensor techniques and home automation. Our goal is to develop a system that can be used in peoples own homes as well as in residential care and that is easy to install, remove and reuse in a new home. We will test the system in  residential care settings and in private homes where a person with beginning stage dementia still lives independently with a healthy partner. The system will preferably also provide outdoor monitoring (garden).

The goal is to encourage people to move by themselves, monitor this and feeding the information into their daily and weekly programme of activity. The nursing staff or the partner of the person with dementia will be able to see how much of the programme is already done by this person. Thus they only have to encourage the goals that haven't been met. If all the goals are met the projection of stimulation will be adjusted automatically. The person with dementia will become the director of his own therapy again. Because of the home automation, which is not just being used as an instrument that stops people at the end of their territory, but as a tool that encourages them to move around and find their way to stimulating activities, these persons will regain control over a part of their life again. Furthermore they will regain the ability to move and preserve cognitive skills, slowing down the progress of their disease and thereby their dignity of life.

The technique will, when it is perfected, be ordered and installed in the new to build residential care facilities and dementia knowledge center of a Dutch care organisation (2012). We expect that this system will be very interesting for a wide variety of care organisations and individual persons, to help empower persons with dementia and reduce the workload of their carers.

We are looking for organisations that will want to do trials in their own country, to establish that the effects are not region specific. We are looking for organisations that can deliver the sensor monitoring and home automation system, fitting to our demands and being able to adjust their hardware to the needs of our programme (wireless, easy to install, remove and reuse). It will take a lot of programming to make the sensors, home automation, care monitoring programme and the audio-visual stimulation work together as one system.

Scientific background:

Epidemiological studies support a close relationship between physical activity and cognitive functioning (Rosano et al., 2005; Verghese et al., 2007). It has been suggested that participating in a physically active lifestyle may protect against dementia (Fratiglioni et al., 2004; Rovio et al., 2005). Similarly, a decrease in the level of physical activity, such as walking, coincides with a decline in cognitive functioning (Rosano et al., 2005).

Indeed, randomized controlled trials have observed a beneficial influence of physical activity such as walking on cognitive functions and mood in older persons without dementia and older persons at risk for dementia or in an early stage of dementia (Kramer et al., 1999; Lautenschlager et al., 2008; Scherder, Van Paasschen, Deijen, Van Der Knokke, Orlebke, Burgers, Devriese et al., 2005).

In view of the expected increase in the shortage of nursing staff (Castle & Engberg, 2009) on one hand, and the impressive beneficial effects of physical activity, is it of great clinical importance to develop new strategies that do not require an additional effort of the nursing staff and is effective in stimulating patients with dementia to remain as active as possible. One such new stimulation strategy emerges from the presence of mirror neurons in the brain. Evidence for a beneficial effect of watching people who walk emerges from studies that show that mirror neurons involved in watching foot movements are located in among others, the frontal lobe (Rocca & Pilippi, 2010).

Mirror neurons for stimulation physical activity in patients with dementia

There is increasing evidence that observing the movements of someone else activates mirror neurons in brain regions, for example the prefrontal cortex, that are also active during the performance of the actual motor activity itself. Activation of mirror neurons can take place by observation of movements presented on a prerecorded video (Cheng, Tzeng, Decety, Imada, & Hsieh, 2006; Proverbio, Riva & Zani, 2009).

We argue that activation of mirror neurons is still possible in early stages of the three most prevalent subtypes of dementia, particularly in Alzheimer’s disease, the most prevalent subtype of dementia. Within this scope, it is important to note that plastic changes are still possible in dementia, a concept paraphrased as ‘use it or lose it’ (Swaab, 1991).