UC Santa Cruz

We are at a moment in history for which the size and rate of growth of the aging population is the highest it’s ever been, with 21% of the human population projected to be 60 years of age or older by 2050. The CDC reports that aging is the greatest known risk factor for developing Alzheimer’s disease, which is the most prevalent form of dementia. Cognitive testing and assessments are traditionally used to aid in detecting cognitive impairment in older adults. However, conventional cognitive assessments can be expensive, time consuming, suffer from recall biases, and may neglect ecological and contextual factors pertinent to the assessment. Ambulatory cognitive assessment (ACA) methodologies provide an avenue to rapidly assess an individual in more naturalistic settings while maintaining ecological validity. Given the sensitive nature of cognitive assessments, traditional ACA studies have focused on its use in clinical psychology. However, studies have shown that older adults are active and interested in monitoring their own cognitive health and well-being. Little to no research has been done examining how ACA systems may be used as an end-to-end solution for self-monitoring cognitive well-being in older adults. Thus, using human-centered design principles, the contribution of this dissertation is fourfold. First, I explore stakeholder needs and requirements with ACA systems through observations and interactions. Second, I present the design of a novel, Web-based ambulatory cognitive self-assessment system (ACSAS) and evaluate its feasibility of use with healthcare social workers through formative usability testing. Third, I provide insight into the context of use surrounding the ACSAS for use by older adults through case studies and group discussions. Finally, I present design recommendations, including data visualization guidelines, for the ACSAS through a summative usability evaluation with older adults. Throughout these studies, I reflect on the lessons learned and design implications of developing the ACSAS or other ACA systems for older adults to self-monitor their cognitive well-being.