A facial expression-based personalization engine (FPE) for monitoring and modulating real-time effective engagement in cognitive training in older adults at risk for AD/ADRD

ABSTRACT How to ensure adherence to computerized cognitive training in unsupervised circumstances (e.g., at-home, self- administered) in older adults at risk for Alzheimer’s disease (AD) or AD related dementia (AD/ADRD) is understudied. The objective of the R61/R33 is to refine and test a novel facial expression-based personalization engine (FPE) for monitoring and modulating real-time effective engagement, with an ultimate goal of enhancing long-term adherence in unsupervised cognitive training in older adults at risk for AD/ADRD. Here, Effective engagement is defined as the extent to which someone is actively engaged and performing with significant attention and enjoyment while training, addressing a balance between adherence and cognitive gains/plasticity from the training. Based on previous work, including ours, we hypothesize that (1) mental fatigue revealed in facial expressions will reflect a trainee’s degree of effective engagement, which can be modified by modulating task novelty; (2) our proposed FPE will ensure the effective engagement in cognitive training by monitoring trainee facial expressions and modulating training in response, promoting the trainee’s long-term adherence to the training and cognitive plasticity. In R61 (Y1-Y2), we will generate the FPE for monitoring and modulating real- time engagement in cognitive trainings in older adults at risk for AD/ADRD by refining our established application programming interface using a Stage I design. In R33 (Y3-Y5), we will conduct a Stage II intervention efficacy study comparing effective engagement and adherence in unsupervised cognitive training between training programs with vs. without FPE in older adults at risk for AD/ADRD. We will address milestones proposed in both stages to (a) ensure the readiness of the proposed FPE for R33 (R61 milestone) and (b) evaluate and further revision of FPE for future implementation test (R33 milestone). Impact: the proposed FPE may assist in monitoring and improving effective engagement and adherence in older adults with unsupervised cognitive training. In the current application, we will test FPE in a cognitive training program called speed of processing training. However, such FPE may be embedded to any computerized cognitive training in future studies to help address adherence related issues.