Alzheimer’s disease is the most common form of dementia. It is a progressive mental deterioration that can occur in middle or old age, most commonly in those over 65. There are 850,000 people with dementia in the UK, with numbers set to rise to over 1 million by 2025; 62% of dementia diagnoses are Alzheimer’s. Many sources and news articles describe Alzheimer’s as an epidemic.
Clearly, there are a huge amount of people affected by the disease. But surprisingly, at present there are not many interventions in the digital realm to support these people, whether they are a patient, carer or family member.
The stages of Alzheimer’s
Symptoms include trouble remembering new names and people, misplacing objects, struggling to plan and organise and di iculty finding the right words in conversation.
At this stage the person will likely still be able to function independently but these memory lapses may become increasingly noticeable and begin to cause some irritation.
Typically the longest lasting stage, usually lasting many years. Symptoms include more severe mild stage symptoms, forgetting personal history and recent events, mood changes, confusion about time and place, inability to recall personal details such as address and personality and behavioural changes.
At this stage care will be needed for the person with Alzheimer’s, there can be risk of them wandering and becoming lost — which can be extremely dangerous.
Care at this stage will be needed for all tasks as the person becomes increasingly unaware of their environment, they may become unable to walk, sit or swallow. Communication become much harder and the person may not be able to communicate pain.
From our research on the nature of the disease, we deduced that a system that is always on hand, can assist in multiple tasks and doesn’t have a high interaction cost would be best. The stand out feature that the Echo is that it’s hands free and doesn’t require a level of dexterity like mobile devices do to use. On this basis we decided that this device was worth investigating further.
We wanted to find out if the Amazon Echo can indeed help patients with Alzheimer’s disease, and if so, how? What can it do to support the lives of Alzheimer’s patients and their carers? We also wanted to know if there were any pain points that had not been addressed by the Echo, and come up with an idea that could assist in this area.
The Amazon Echo
The Amazon Echo is a smart speaker, it is voice activated and, also has its own voice, Alexa, who acts as the user’s assistant. It became available to the general public in the US in June 2015 and since then Amazon have brought out subsequent products to complement it, the Tap and the Dot.
Most people who own any of the Echo family use the device(s) to turn their home into a smart home. The Echo offers ways to make turning lights on and off, turning heating up and down, for example, all voice activated. It can also play music through its 360 degree speaker and additional ‘skills’ or apps which have been opened to third party development, allowing games, taxi and food ordering plus endless other future possibilities.
But perhaps the most exciting feature is the Echo’s ability to access Bing and quickly answer the questions it is asked. It can also connect to Google Calendar, one of many features that could be utilised by those with Alzheimer’s. The Echo has the potential to be extremely useful for those suffering with Alzheimer’s and those who care for them.
The Echo ecosystem
Amazon allows you to set up households on your account. This means that you can set up a patient’s Echo and control it remotely through the app. This has many benefits for both the carer and the patient. One feature we especially like is the ‘history section’ which allows the carer to view all of the questions the patient has been asking the Echo. This allows the carer to monitor the patient’s well-being.
How can the Echo help Alzheimer’s patients?
However the person’s dexterity is, they can use the Echo as there is no typing (or touch) involved. Later on in the condition, dexterity can worsen so this may be a helpful feature.
It never gets frustrated
Someone with Alzheimer’s may need to ask the same question over and over, like ‘What is today’s date?’ They avoid asking as they feel like it causes annoyance in their carers — which it sometimes does. Alexa never gets frustrated though and never changes her tone of voice to sound annoyed, so the person can ask them any question and get an answer as many times as they like.
It can record conversations
A carer can view the usage of the Echo and what interaction the person had with it. This could lead to useful inferences, like if the Echo’s history shows many requests late at night, this may indicate to the carer that the patient is struggling with insomnia. If the person has been using the Echo for leisure activities like listening to audiobooks in the afternoon and history shows that this suddenly stops it may mean the person is feeling depressed, or experiencing some other kind of change which can then be investigated by the carers.
A carer can set up a Google calendar so that the Echo can access it. The carer can then put people’s birthdays and other important events on it. The patient can then ask “Alexa, what’s going on this week?” or “Alexa, what’s going on today?” as many times as they need, and always know if there’s an important date coming up soon.
It can set alarms & reminders
The Echo has an alarm feature which can be used for far more than just waking up on time; one can set an alarm to go off each day to remind someone to take their medication for example.
The ‘Thunderstorm Sounds’ skill plays a loop of a thunderstorm or ocean and rain sounds to induce relaxation. Because the nature of Alzheimer’s means that both the patient and carers can experience anxiety and stress, taking time to sit down and relax is important for both’s well-being. This is just one example of a skill for relaxation; there are many more such as music playlists accessed through Amazon music & Audible.
Some of our favourite Echo skills
The first of a suite of skills Hacking Alzheimer’s are building to use Alexa with Alzheimer’s patients. Memory Lane ‘connects users to the past’. The user can ask for a descriptions and audio clips from a defining event in history from that year. Causing nostalgia, improving mood and possibly triggering memories.
Ask My Buddy
Ask my buddy is a personal alert network. If someone is at home on their own, or if they fall in the middle of the night with no way of getting to or using a phone they can simply ask Alexa to alert someone for them. Ask my Buddy sends a text, email and call to someone who is registered as a contact to tell them that the person who requested the alert needs help and needs to be checked on.
Audible is a service owned by Amazon for audio books. The Echo can be used with Audible to play Audio books. Patients with Alzheimer’s could benefit from the relaxing nature of being read to. If the patient is suffering from insomnia, audio books could be a good distraction or possibly help them to get to sleep. The audio app also allows users to easily start where they left off or rewind for a recap at any time.
With the assistance of a carer, Google calendar’s integration with the Echo can be an excellent tool to make an Alzheimer’s patient’s life easier. The patient can ask Alexa what they have on for the day as many times as they like with no-one getting frustrated at having to repeat themselves. The carer can put anything in the patient’s calendar from the Alexa app, and can imbue entries with additional helpful info; for example ‘David is coming round today — he is your x and is going to talk to you about y’. By giving the patient this easy access extra information about the event, awkwardness and anxiety could be reduced.
Our skill idea
Once we were confident in our research and we had got to grips with what the Echo could do, we set out to link problems with the various different skills which were available. We made sure that each skill had a tangible benefit for the patient and wasn’t just being used for the sake of it. This helped us with the next stage which was thinking about the patient’s journey through their day.
We believe it is evident that the Echo can be useful throughout the day, everyday. This journey map shows the activities of a patient, and how the Echo can assist at any of these points, either with it’s basic features or with the skills that we have identified. Where there is currently a gap though, is when the patient is interacting with family and friends. Problems arise when the patient can’t remember their relationship with the person, or their name or recent goings on in their life. This is a part of the patient’s life that the Echo does not currently address; we wondered how we could enable it to do so.
Our idea is the ‘My circle’ skill. Which uses the Echo to help patients stay up to date with the people they are close with. The skill allows people in the Echo household to manage a set of profiles of the people that the patient wants to keep up to date with.
The profiles can include anything, although we have a few suggestions which act as prompts. Entries such as full name, age, birthday, profession and relation would be recommended, though the carer can judge which ones are relevant for the individual patient’s needs. There is also the functionality for those with profiles to record messages and updates for the Echo to play to the patient when they ask for their circle’s updates or a specific person’s updates. These recorded messages could be anything from recordings of the latest song they learned on piano to a voice update about how a house move went; anything that the person wants the patient to know so that they can keep in the loop.
We see the patient using this before a call or outing with one of the people with a profile. The patient can refresh themselves on the person they are going to talk to as many times prior that they want. We anticipate that it will empower the patient and allow them to communicate that they are staying in touch with their loved ones and are taking an interest in their life.
What we’ve learned
During this research project we learned about Alzheimer’s disease, its stages and how each stage affects patients (we are particularly aware also that every patient is a affected differently). We also researched the capabilities of the Amazon Echo and the skills that are already out there, then how these skills and features could fit into a patient’s life. All these areas of research lead us to our proposed additional skill.
In addition, from our research we learned the following three points about assistive technology and how it can be used by Alzheimer’s patients:
• The rise in conversational UI will be beneficial for the area of assistive technologies
• New, innovative products intended for general use can in some instances be leveraged towards assistive care, after being carefully researched
At this stage of development, we believe that the Amazon Echo is beneficial to those with early — mid stage Alzheimer’s. Those in the later stages need more intensive care and should be assisted in all activities by a carer.