Turning apathy into action in neurodegenerative disease: Development and pilot testing of a goal-directed behaviour app

Figures & data

Table 1. Phase I and II participant demographics and baseline features.

Phase I	Total Group
N	6 (2 MCI, 2 AD, 2 bvFTD)
Age	69 (8.9)
Sex	1 Female; 5 Male
Racial Identity	6 White
Education	15.3 (3.3)
Global CDR plus NACC FTLD	0.9 (0.2)
MMSE	22.2 (3.1)
NPIQ Sum	4.2 (1.3)
NPIQ Severity Sum	7.5 (5.5)
Phase II	Total Group	MCI	AD	bvFTD
N	24	8	8	8
Age	70.4 (8.4)	70.1 (4.5)	70.1 (9.0)	65.0 (7.8)**
Sex	10 Female; 14 Male
Racial Identity	22 White; 2 Black/AA; 1 Multiracial
Education	16.1 (2.8)	16.8 (2.8)	16.4 (2.9)	15.4 (2.9)
CDR Total	4.4 (2.2)	2.6 (1.0)	4.8 (1.6)	5.9 (2.5)**
Global CDR plus NACC FTLD	0.69 (0.4)	0.4 (0.2)	0.8 (0.3)	0.9 (0.5)
MMSE or TICS*	24.6 (2.9)	25.3 (2.2)	23.6 (1.9)	25.0 (4.1)
NPIQ Sum	5.0 (2.8)	4.5 (2.7)	4.0 (2.6)	6.5 (2.6)
NPIQ Severity Sum	8.8 (6.1)	7.0 (4.0)	6.1 (5.0)	13.3 (6.9)**

Notes: CDR: Clinical Dementia Rating; MMSE: Mini-Mental Status Examination; TICS: Telephone Interview for Cognitive Status; NPIQ: Neuropsychiatric Inventory Questionnaire.

*TICS scores converted to MMSE scores.

** Group difference between bvFTD and MCI/AD, p < .05.

Figure 1. Example Goal Assessment Scale (GAS) Worksheet. The GAS allows for individualized goals to be established on a standard scale (−2–2). The above table is an example of four goals (reading, walking, showering, washing dishes) across each of the four goal categories (Brain Health, Body Health, Personal Care, and Housework). The goal attainment levels operationalize the behaviour in order to determine if there is an improvement. The level of change ranges from Much (−2) or Somewhat (−1) Less Than Expected, to Expected (0), to Somewhat (1) or Much (2) Better Than Expected. The goals set in this study were “change goals,” meaning the reported level of baseline behaviour was set at −1. Figure 1

Figure 2. App daily use over study participation depicts average daily use of ActiviDaily during each of the four weeks of study participation. The clinical group (MCI, AD, or bvFTD) data is presented separately.

The MCI group started out with lower average daily use, around 4.5, compared to 6.5 in the AD and bvFTD groups. Over weeks 3, 4 and 5, all groups had an average daily use between 4 and 6.

Table 2. App use over study participation.

	Week 1 Mean (SD)	Week 2 Mean (SD)	Week 3 Mean (SD)	Week 4 Mean (SD)	Total Mean (SD)
Days Used	5.71 (1.98)	5.60 (1.64)	4.95 (2.30)	4.76 (1.79)	19.38 (7.47)
App Opening	34.00 (28.57)	24.45 (20.01)	19.53 (15.24)	16.76 (10.17)	88.52 (64.32)
Activity Completion	42.00 (35.67)	46.40 (24.48)	46.20 (33.91)	46.29 (25.57)	225.75 (166.46)
Skips	2.95 (2.97)	4.00 (5.90)	2.57 (2.75)	1.67 (2.27)	11.19 (9.43)
Snoozes	2.33 (3.25)	2.71 (4.69)	1.76 (3.14)	1.57 (2.84)	8.38 (11.62)

Figure 3. Percent of goal achievement on GAS by activity area illustrates the percent goal achievement for all goals set at each level of the Goal Attainment Scale (GAS). Goals are presented separately for each of the four goal categories (Brain Health, Body Health, Personal Care, and Housework). Achievement of a GAS score of 0, 1 or 2 indicates improvement on the 5 point GAS scale from a baseline behaviour of −1. A score of −1 indicates no change from baseline and −2 indicates a decline in the behaviour. Figure 3

is a bar graph that illustrates the percent goal achievement on the Y axis for all goals set at each level of the Goal Attainment Scale (GAS) on the X axis. Goals are presented with separate bars for each of the four goal categories (Brain Health, Body Health, Personal Care, and Housework). Achievement of a GAS score of 0, 1 or 2 indicates improvement on the 5 point GAS scale from a baseline behavior of −1. A score of −1 indicates no change from baseline and −2 indicates a decline in the behavior. The majority of goals were achieved at the expected, somewhat better than expected or much better than expected levels and are highlighted on the right side of the bar graph.