Combatting Alzhiemers Disease through IOS Tablet Platform

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Material Information

Title:
Combatting Alzhiemers Disease through IOS Tablet Platform
Physical Description:
Project in lieu of thesis
Language:
English
Creator:
Difato, Tim
Publisher:
College of Fine Arts; University of Florida
Place of Publication:
Gainesville, Fla
Publication Date:

Notes

Abstract:
For my Project in Lieu of Thesis, I have built an iOS quiz application that targets elderly Alzheimer’s patients to help impede their loss of memory and provide research data to aid in finding a cure. This application displays a question that asks the participant to select the picture of a certain relative or familiar object. The user interface allows for simple answer submission by literally tapping the picture the participant believes is correct. The computer then notifies the user if the answer is correct or incorrect by either moving onto the next picture or displaying a Red “X” over top of the picture they chose. While the user is taking the quiz, the application is recording data to an internal database. The database records two sets of information, an individual quiz and each individual question of that quiz. Once the quiz is completed, the administrator can recall the database and find how a participant scored on the most recent quiz or look at each individual question of that quiz. In addition, because this system is built around an internal database, the administrator can recall any quiz ever taken on that device and search individual predicates to reveal trends or patterns in the results. The database records the score of each quiz, the time stamp of when the quiz started, the amount of time it took to complete the quiz, the difficulty level of the quiz, and the picture’s attributes such as, gender, race, hair color, etc. The data is then broken down on the individual question level. If the quiz is too easy for the participant, the administrator has the ability to adjust the difficulty level of the questions. Each question is populated with the correct picture as well as three incorrect pictures. The level of difficulty dictates the common attributes found in the three incorrect pictures to the correct one. For example, if the difficulty is set to “Hard”, the three incorrect pictures would be of people who have similar physical attributes as the correct image. In contrast, if the difficulty of the quiz is set to “Easy”, the quiz would randomly populate the three incorrect pictures regardless of the correct picture’s race, age or hair color. Finally, the application’s questions are populated by an external website which allows family members or friends of the participant to wirelessly submit new questions to the user. Once submitted, a server running PHP creates an XML document, which is then sent to the iOS device running the quiz application. This allows family members to aid in their loved ones recovery/research regardless of location. In addition, the quiz returns all of the database results to the server, which can be accessed by researchers and family members to help find a cure for Alzheimer’s disease. For my defense, I will be displaying the application in its entirety including all of the features described above.
General Note:
Digital Arts and Sciences terminal project

Record Information

Source Institution:
University of Florida Institutional Repository
Holding Location:
University of Florida
Rights Management:
All rights reserved by the source institution and holding location.
System ID:
AA00016992:00001


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1 COMBATTING ALZHEI MER'S DISEASE WITH FAMILIAR FACES By TIM DIFATO A PROJECT IN LIEU OF THESIS PRESENTED TO THE COLLEGE OF FINE ARTS OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS UNIVERSITY OF FLORIDA 2013

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2 2013 TIM DIFATO

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3 Dedicated to my mother and father for their continued support, love and dedication. To my grandfather Big Mike, who sadly was plagued with Alzheimer' s disease for the last several years of his inspiring life. Most importantly, this is dedicated to the one who paid it all for me Jesus Christ. May my life, work and devotion be for your glory.

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4 ACKNOWLEDGMENTS I thank my chair and board committee for their support. I also thank the countless people that have helped me understand iOS programming and applying my studies to the business field.

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5 TABLE OF CONTENTS P age ACKNOWLEDGMENTS ................................ ................................ ................................ ... 4 LIST OF FIGURES ................................ ................................ ................................ ........... 7 LIST OF ABBREVIATIONS ................................ ................................ ............................ 10 CHAPTERS 1 INTRODUCTION ................................ ................................ ................................ ..... 13 Personal Motivation ................................ ................................ ................................ 13 Medical Introduction to the Alzheimer's Disease ................................ ..................... 14 Project Background ................................ ................................ ................................ 15 2 PROJECT OVERVIEW ................................ ................................ ............................ 19 Project Implementation ................................ ................................ ............................ 19 Patient Comfort ................................ ................................ ................................ 19 Care Giver Tool ................................ ................................ ................................ 21 Family Participation ................................ ................................ ........................... 22 Doctors and Researchers ................................ ................................ .................. 23 3 TECHNOLOGY ................................ ................................ ................................ ........ 27 Why iPad? ................................ ................................ ................................ ............... 27 Application Language and Workflow ................................ ................................ ....... 28 Server Language and Workflow ................................ ................................ .............. 31 User Interface Design ................................ ................................ .............................. 32 Future Improvements ................................ ................................ ............................... 34 4 MARKETING RESEARCH ................................ ................................ ...................... 51 Market Demand ................................ ................................ ................................ ....... 51 Target Market ................................ ................................ ................................ .......... 52 Competitors ................................ ................................ ................................ ............. 53 Focus App Store: ................................ ................................ ............................... 53 Brain Map: ................................ ................................ ................................ ......... 54 Alzheimer Cards ................................ ................................ ................................ 54 Brainy App ................................ ................................ ................................ ......... 55 It's D one! ................................ ................................ ................................ ........... 56 What day is it? ................................ ................................ ................................ ... 56 Family Connect User Testing ................................ ................................ .................. 57

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6 Conclusion ................................ ................................ ................................ ............... 59 LIST OF REFERENCES ................................ ................................ ................................ 72 BIOGRAPHICAL SKETCH ................................ ................................ ............................. 77

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7 LIST OF FIGURES Figure page Figure 1 1. Digital representation of dead cells being clouded by plaques, w hich are abnormal groups of protein in comparison to healthy cells. ................................ 17 Figure 1 2. Digital representation of multiple stages of AD. Top left displays earliest form of AD. Top right displays mild to moderate Alzheimer's stage. Bottom center displays severe Alzheimer's stage, ................................ .......................... 17 Figure 1 3 Digital comparison between a healthy brain and a brain with advanced AD. ................................ ................................ ................................ ....................... 18 Figure 1 4. Digital comparison between a healthy brai n and a brain with advanced AD. ................................ ................................ ................................ ....................... 18 Figure 2 1. Example of a question inside of Family Connect. The correct picture (top left) surrounded by three incorrect images. The question was loaded from the Internet. By tapping the ima ge you move onto the next question. ........ 25 Figure 2 2 Example of the settings menu. Here you can set the question difficulty which affects the incorrect images that are displayed in the quiz. The harder the setting, the closer t he incorrect images are to the correct one. It also allows the caregiver to search previous quizzes taken and view the scores, as well as manually send the scores to the Internet. ................................ ........... 26 Figure 3 1. An image of the iPad user inter face. Each application shown by a 72x72 pixel icon. ................................ ................................ ................................ .. 37 Figure 3 2. Results of user testing from a group of 3 participants. This shows the time it took them to complete each question as well as the average question time of 3.7 seconds. ................................ ................................ ............................ 38 Figure 3 3. Shows the breakdown of the individual question results. This information can be found inside the Family Connect's settings page. Here you can see where the individual question timer records the data f or Figure 3 2. .................. 38 Figure 3 4. Shows Family Connect's Main Menu. Here the participant can click the big button "Tap Here to Begin" to start the quiz. The bottom right orange button refreshes the quiz. The tools button goes to the settings menu. .............. 40 Figure 3 5. Shows the splashview.m file. Displays the IBAction to start the quiz. ......... 41 Figure 3 6. (below) Shows the quiz.m file. Here we see the steps the quiz takes when load ing. It resets the answers from previous quizzes, sets the ID, loads the question, randomly shuffles the 4 images for the question and then assigns them to the buttons. ................................ ................................ ............... 41

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8 Figure 3 7. Shows the quiz calling the TDQuestionStore to grab all the questions. Once the array of questions is called, the computer displays the first object in that array, i.e. Question #1. This also shows the computer grabbing the incorrect images from the ImageStore. ................................ ............................... 42 Fig ure 3 8. Shows the quiz taking the 3 incorrect images ("randomPictureOne", "Two" and "Three") as well as the correct image and putting them into an array called mixQuestions. This allows the questions to be randomly shuffled and assigned to buttons. This way, the images do not show up on the same button every time the quiz is taken. You also see the correct image attributes being added to theTDAnswer Store, which allows it to be saved once the quiz is completed. (i.e. the image's gender, race, image URL, h air and name.) ................................ ................................ ................................ ................. 42 Figure 3 9. Shows the quiz finding the difficulty settings. If it is set to "1" in the settings, it will grab all of the images from the incorrect image Store and sort only the ones that match the correct im age's "Race" and "Gender". If there are no images that match, it reduces the settings by "1" and grabs all the incorrect images. In this case, "medium" would drop to "easy" if there were no attribute matches. ................................ ................................ ........................... 43 Figure 3 10. Shows the quiz entity that has eight attributes. In addition, every question answered becomes an entity saved in Core Data and it too has several individual attributes. ................................ ................................ ................ 44 Figure 3 11. Shows the website where you can submit questions and images to the iPad app. Click here to visit page: http://timdifato.host ed.me/thesis/submitquestion.php ................................ ................................ ........ 45 Figure 3 12. Shows the XML document created by entering information and uploading images to the website. This is what the application reads every time it loads. ................................ ................................ ................................ ........ 45 Figure 3 13. Shows the PHP script error which is revealed if information on the website is not entered in correctly. ................................ ................................ ...... 46 Figure 3 14. S hows the server. Here you can see the database file being stored, (FamilyConnect.sqlite) as well as all of the .php files to run the website. ........... 46 Figure 3 15a. Shows Sample 1, "Dark Blue" design for the application. ........................ 47 Figure 3 15b. Shows Sample 2, "Lite Blue" design for the application. ......................... 48 Figure 3 15c. Shows Sample 3, "Lite Green" design for the application. ....................... 49 Figure 3 16. Shows the open ing load screen for sample 2, "Lite Blue" design. ............. 50 Figure 3 17. Shows the first Dropbox.com homepage design. ................................ ...... 50

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9 Figure 4 1. Shows the percentage changes in selected causes of Death. .................... 61 Figure 4 2. Shows the number of deaths due to Alzheimer's sorted by State. .............. 62 Figure 4 3. Shows the projected percentage increase of people diagnosed with AD. ... 63 Figure 4 4. E stimated lifetime Risks for AD by Age and Gender. ................................ .. 64 Figure 4 5. Proportion of AD sorted by Race. ................................ ................................ 64 Figure 4 6. Displays screen shots of Focus Application. ................................ ............... 65 Figure 4 7. Displays screen shots of Brain Map. ................................ ........................... 65 Figure 4 8. Displays screen shots of Alzheimer Cards. ................................ ................. 66 Figure 4 9. Displays screen shots of Brainy App. ................................ .......................... 67 Figure 4 10. Displays screen shots of It'sDone! ................................ ............................. 67 Figure 4 11. Displays screen shot of What Day is It? ................................ .................... 68 Figure 4 12a. Survey given to focus group 1 participants. (Page 1/2) ........................... 69 Figure 4 12b. Survey given to focus group 1 participants. (Page 2/2) ........................... 70 Figure 4 13. Shows the design style used for testing. For pictures of the full design layout see Figure 3 15. [Figure 3 15] ................................ ............................. 71 Figure 4 14. Results of focus group one. ................................ ................................ ....... 71 Figure 4 15a. Survey given to focus group 2 participants. (Page 1/2) ........................... 72 Figure 4 15b. Survey given to focus group 2 participants. (2/2 pages) .......................... 73 Figure 4 16. Results of focus group two. ................................ ................................ ....... 74

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10 LIST OF ABBREVIATIONS AD A LZHEIMER S D ISEASE : A dementia disease that attacks a person 's brain cells, reducing their ability to recall info r mation and recognize familiar obj ects. This disease will be expounded upon in greater detail throughout the paper. SDS S UND OWNERS S YNDROME : A mood disorder common ly associated with Alzheimer's d isease. It is where a patient lose s track of time believing it is later in the evening than it truly is and vice a versa thus becoming agitated and confused. I OS The name of the oper ating system for Apple Company's mobile tablet/ phone product line such as, iPhone and iPad.

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11 Abstract of Project in Lieu of Thesis Presente d to the College of Fine Arts of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts COMBATTING ALZHEI MER'S DISEASE WITH FAMILIAR FACES By Tim Difato May 2013 Chair: Angelos Barmpouti s Major: Digital Arts and Sciences The purpose of this project in lieu of thesis is to create an iOS quiz application that helps impede the loss of memory from an Alzheimer patient and provide research data to aid in finding a cure. In addition, this pro ject allows family members or friends of a person with Alzhei mer's disease to actively participate in finding a cure by generating the specific content that their friend or family member would see once they run their application. In no way am I stating tha t this application will directly cure or restore a brain with any stage of Alzheimer's disease. Currently there is no cure for Alzheimer's and it is the 6 th ranked cause of death in the United States. There are few partial solutions on the market today to help individuals with AD as it is a disease that literally shrinks the brain over the life cycle of the disease With that said, this application will keep the patient s brain active and stimulated on a daily basis by asking questions that are unique to th e individual participant. The questions are created by family members through an online website that ports the content directly to the iPad This product is different from other potential solutions in that the application is specific ally tailored to the in dividual user rather than one single universal application for all users. While it may seem like a simple quiz applicatio n to the Alzheimer patient, it is actually logging data

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12 about the patient for doctors to observe. Such data consists of quiz/question s uccess rate, que sti on specific demographic data, time taken to complete each quiz/question and several others that will be discussed in this paper The research goal of this application is to take the data and parse it into valid strings of information for analysis to find patterns in the life cycle of the Alzheimer's disease as well as stage progression for a large group of users. The purpose of this application is to build research information on this disease while also aiding the patient and caregiver in side the home.

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13 CHAPTER 1 INTRODUCTION Personal Motivation In 2007 my 87 year old grandfather was diagnosed with mild Alzheimer's disease (AD) By viewing the short term signs and symptoms doctor s were able to approximate the stage of Alzheimer's my gran dfather was currently in, but were unable to verify with certain ty the severity of the disease and the speed at which it would progress Within a few years, my grandfather's disease matured rapidly, to the point where he could only remember 4 out of his 26 grandchildren. He was easily agitated and became unaware of his sur rounding s time and space. His mind became less active and he clung to his wife, which drained her physically and emotionally. Ultimately, Alzheimer's disease led to th e deterioration of h is mind and the passing of his life Sadly, stories and experiences similar to my grandfather's are heard far to often by millions of Americans. Families battling Alzheimer's disease are caught in a multi faceted war, juggling financial burden s with trea tment option, keeping the ir loved one s mind active an d stimulate d while also dea ling with the emotional stress of a family member with this disease. If that weren't enough, families come to the realization that doctors do not have a cure for this disease and need more patient data to find a solution. As noted in my abstract, this project's goal is to help the daily caregiver the family member and the doctor by presenting the patient with a daily task to complete on the iPad. This task would connect the p atient with family members from around the globe while also recording and sending viable data back to doctors and researchers to help find a long term permanent solution to Alzheimer's disease.

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14 Medical Introduction to the Alzheimer's D isease Alzheimer's disease is classified as a form of dementia, which targets the brain and slowly eats away at a person's memory. Dementia is defined as any disease that results in the loss of brain function, which affects memory, decision making, language and thinking. On a biological level nerve cells in the brain known as neurons are being damaged or destroyed which inherently lead s to the distortion of human functionality and emotional discernment allowing fear of abandonment and depression to become common side effe cts of dementia. Doctors have broken down Alzheimer's disease into seven stages. E ach stage reveal s harsher symptoms than the previous due to increased brain cell damage and deterioration The brain is gradually infiltrated by what doctors describe as "ta ngles" [1] which are twisted strands of a protein that are a cause for t issue loss and cell destruction [Figure 1.1] Figure 1.2 shows the process of these tangles and how they affect different areas of the brain as the disease progresses from stage to stage. [Figure 1.2] Figure 1.3 and figure 1.4 comp are the average size of a healthy brain and a brain that has been damaged due to advanced Alzheimer's disease. [ Figure 1.3] [Figure 1.4] Dementias do not result in the loss of memory simply because an area of the brain is not working properly In actuality, people lose their memory and decision making ability because certain areas of the b rain are physically being destroyed and deteriorating [2] The most common form of dementia is Alzheimer's, which accounts for 60% 80% of all cases. [3] In addition to being the most commonly seen form of demen tia, it is also one of the most unknown. The 2012 "Alzheimer's Disease Facts and F igures R eport from the Alzheimer's Association writes, Although research has revealed a great deal

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15 about AD, the precise physiological changes that trigger the development of AD largely remain unknown. [4] Project Background In America, every 68 seconds a person develops Alzheimer's disease. [5] An estimate d 5.4 million America ns are living with Alzheimer's d isease. T hat n umber is estimated to increase by 10 million more people with the aging of the baby boomer generation. AD is a serious issue in the world today, but the problem truly unfolds when you look at it on a case by case level. Daily struggles for patients vary d e pending on the stage of AD. Advanced Alzheimer's can lead to issues such as thrown off sleep cycles, aimlessly walking the neighborhood, losing ones sense of direction, and forgett ing familiar faces. As noted in earlier sections, my grandfather only rememb ered 4 of his 26 grandchildren. The 4 that he remembered were the ones that visited weekly, which meant if you lived far away you were forgotten. Because of this certain family members felt hopeless in partnering with the recovery and wellbeing of their loved one. With that in mind, as AD progresses, patients start to feel abandoned because they cannot remember their communities and families around them. Consequently, the fear of losing the ones they are closest to creeps in, so naturally they respond by clinging to their spouse or daily caregiver. I received a first hand experience with my grandfather who clung to my grandmother, which physically and emotionally wore her out. Several times I would sit down with him to give my grandmother and the paid caregiver a break. He slowly would open up to me and responded well to familiar objects, stories and faces. His o verall attitude and demea nor went from anxious and frustrated to relaxed and friendly.

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16 Several caregiver techniques that are used by medical p rofessionals support the methods that I described above and have statistically shown positive results through medical testing and studies. One research study took 37 Alzheimer's patients and applied a cognitive intervention technique that consisted of, "tr aining in face name associations, spaced retrieval, and cognitive stimulation." [15] The study writes that, "During the intervention, AD patients showed significant improvement in recall of personal information, face name recall, a nd performance on the Verbal Series Attention Test. [16] Though this survey did not prove to provide long term relief to the average signs and symptoms of the patient, it did display positive short term results to memory recall an d overall quality of life for the patient. Another study, which used board games to help increase patient care and family involvement in the patient's medical treatment, provided a three fold increase in patient engagement. In addition, patient caregivers and staff members were educated on the patient's family history and background due to the increased involvement of the family [17] When looking at my grandfather's specific case and the caregiver research available, I realized th at he didn't simply need a medical drug to help him; h e needed someone or something familiar to keep his mind active and occupied He needed a tool that would help increase his quality of life, mental state and the family involvement in his life. This is why I created a medical iOS application for Alzheimer patients called "Family Connect for Alzheimer's".

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17 Figure 1 1. Digital representation of dead cells being clouded by plaques, which are abnormal groups of protein in comparison to health y cells. [18] Figure 1 2 Digital representation of multiple stages of AD. Top le ft displays earliest form of AD Top right displays mild to moderate Alzheimer's stage. Bottom center displays severe Alzheimer's stage [18]

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18 Figure 1 3 Digital comparison between a health y brain and a brain with advanced AD. [18] Figure 1 4 Digital comparison between a health y brain and a brain with advanced AD. [18]

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19 CHAPTER 2 PROJECT OVERVIEW Project Implementation As described in my abstract, t he application is a basic digital quiz that the applicant would use daily. Family Connect for Alzheimer's (Family Connect) asks the participant question s that are specifically generated by the family members online. A sample question would be, Hi mom! Its me your Son Jack. Tap on the picture of me. I love you. Below this question would be four pictures of people, three of which would be incorrect while the last one is the cor rect image of Jack [Figure 2 1] The participant taking the quiz would simply tap the picture that is correct. Following the question, another will appear and the p rocess is repeated until completed This application was built for four reasons; patient comfort, basic caregiver tool, family participation and medical data research. Patient Comfort Early onset AD occurs around the ages of 60 65. P atients in this stage are consciously aware that they are losing their memory. It usuall y begins by forgetting basic daily items such as where your keys are located or if you've checked the mail today. It is not uncommon for early AD patients to ask themselves if they have completed a certain task already, knowing that they very well could ha ve done this task several times today This can leave an overwhelming sense of hopeless ness inside of a person knowing they should know a certain topic but simply cannot recall it. Family Connect for Alzheimer's allows people with earlier signs of AD to f eel like they are

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20 preemptively attacking their disease and working out their memory. Though this application primarily targets patients who show more serious si gns of advanced Alzheimer's, Family Connect has the ability to be set to a more difficult settin g for people who are overly successful at the game and find it to o easy. [Figure 2 2] If nothing more, this application allows people with early onset Alzheimer's to feel like they are actively combatting the affects of this diseas e by strengthening their mind with familiar images. As I alluded to earlier, patients with advanced AD cling to the ones they a re familiar with due to the fear of being alone or not knowing how to solve a problem. At this stage, they are mostly unable to consciously reflect and acknowledge the disease that is present in their body. Family Connect is primarily built for patients in this stage of AD. The application tries to connect familiar faces with active questions to help patients find a sense of belong ing rather than abandonment. In 2012, 1 in 7 Alzheimer's patients lived alone and half of them had no main care giver. These people are more susceptible to injury due to malnutri tion, wandering, falls and self hygiene This application would become a perfec t outlet for these people to be able to connect to familiar faces in their community. An online Alzheimer's awareness forum, which allows caregivers and family members an outlet to expand on their findings and experiences shows the majority of family car egivers encounter these abandonment issues with their patient [6] One author of a forum wrote about his mother Dotty saying, "When I left Dotty alone she quickly

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21 became scared, confused, anxious, and I soon learned she feared that I was going to abandon her Or worse, put her in a home to rot. Family Connect allows patients to interact with family member s indirectly. Keep in mind, this is not a live chat service or two way communication device between patient and family member. O ne of the goal s of this application is to help the patient feel a sense of community by reminding them of the friends and family members who care about them. A major feature to be implemented into the next phase would be the ability to play a recorded audi o sample of the question being read a loud by a familiar voice This way the patient would be even more submersed in the experience and hopefully reduce the barrier between the patient indirectly interacting with family members by making them believe they are communicating with that person in real time. Care g iver Tool Family Connect for Alzheimer's is not only an application for the benefit of the patient, but also the caregiver. A care giver can be described as a paid or non paid attendant who oversees th e daily wellbeing of the patient. In most cases, the spouse of the patient is the direct caregiver. In cases like my grandmother, a paid caregiver oversaw my grandfather during the day and my grandmother watched him at night. As mentioned above, AD patien ts latch onto familiar faces and usually keep them in line of sight. If a person leaves the patient to o long, the patient will aimless ly wander in search of tha t person. In addition, once sun downers syndrome starts to have an effect on patients, they begin to believe the day is later than it truly is. [14] Because of this, advanced AD patients prepare for bed earlier than normal and expect their significant other to join them for sleep. This is a very common scenario where the

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22 patie nt then becomes irritated because they don't understand why their loved one does not want to join them A ll of these small daily events can add up to become a major emotional and physical burden for the caregiver. If the caregiver is a spouse or family member, the benefit is that they get a daily break from the duties of caring for their loved one with Alzheimer's. The app should be used daily at the same time to create a schedule for the patient This has several advantages. Firstly, this reduces the v ariables introduced when evaluating the results. For example, b y having the patient take the quiz daily at 4pm, researchers can highlight mood cha nges, patterns and habits accurately because the quiz was taken with c onsistent environmental setting s The s econd reason for establishing a routine is because routines are one of the first things that are lost once the disease starts to infect the brain [7] One of the best techniques used to help AD patients is to establish a daily routin e so that they can expect certain things at a certain time. This gives them a reason to actively s tay aware of the day and time. Family Participation As mentioned in my abstract, on e of the goals for Family Connect is to allow family members the ability to actively help in the treatment and care of their loved one with AD. Regardless of location and proximity to their loved one family members can populate the content of the application for the betterment of the patient This application requires the soci al involvement of outside parties away from the immediate caregiver. Without the participation of family members generating questions for the application, Family Connect will be an ineffective tool to retrieve data and entertain the patient In

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23 most scenar ios, extended family members want to be involved but cannot find a way. This allows them the ability to not only populate the quiz with questions, but also to see the results of those questions and monitor the progress of the participant. Once a quiz has been completed, the application automatically sends a compiled database to the server to be backed up and displayed on the website Currently the website does not parse the database file and display the data online but this is an attainable goal for any f uture versions of the application. With this structure in place, the family would have the ability to upload questions and see the results of their work. This allows the family to feel included and informed on the status of their loved one. Doctors and R esearchers Just as family members can view the results of the quiz doctors and researchers will also have that ability online With this information, doctors ca n match data results and trends with previous ly studied material to help find new areas of Alz heimer's behavior For instance AD patients in mid to late stages quickly acquire what doctors' call Sund owners syndrome. [14] Patients believe the time of day is later than it actually is and get anxious. Their whole internal clo ck begins to become thrown off and as a result they wake up earlier than usual. Add this effect to their distorted memory and you find people with advanced Alzheimer's disease quickly become lost and aimless ly wander With this in mind, if a patient uses this application every day at 4pm doctors can take the data recorded by the quiz to help discover t he severity of the patient's side effects The application allows the administrator doctor, or researcher the ability to track past results in order to fi nd commonalities in the participant 's answers Family Connect records the demographic data of each question 's image in the quiz. The administrator

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24 can now search by predicates to find which images the user was success ful in answering and which they struggl ed with. A possible example could be, grandpa remembers all women but struggles remembering men, more specifically men with black hair. Another example could be, grandpa remembers events before 1975 but not after. If this free application were in use by 2, 000 participants, doctors and researchers would now have a large, at home focus group from which to pull daily data from. This application was built to bring value to several areas rather than simply the app user. Family Connect for Alzheimer's is looking to bring comfort to the patient, relief to the caregiver, awareness to the family members and data to the doctors to help find solutions to Alzheimer's disease.

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25 Figure 2 1 Example of a question insi de of Family Connect The c orrect picture (top left) surrounded by three incorrect images. The question was loaded from the Internet. By tapping the image you move onto the next question.

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26 Figure 2 2 Example of the settings menu. Here you can set the question difficult y which affect s the incorrect images that are displayed in the quiz. The harder the setting the closer the incorrect images are to the correct one. It also allows the caregiver to search previous quizzes taken and view the scores, as well as manually send the scores to the Internet.

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27 CHAPTER 3 TECHNOLOGY Why iPad ? In 2010, Apple Corporation release d their firs t tablet device called the iPad and today over 84 million have been sold The iPad runs a proprietary oper ating system called iOS. This operatin g system was specifically built for Apple's line of mobile devices such as the iPhone, iPad and iPod. The device was built with a 7.75x5.82 liquid crystal glass touch screen (diagonally 9.7 inches) and one main "Home" button which is a physical button loca ted directl y below the screen. The iPad has a sleek desi gn and simple interface. The user interface (UI) is an assembly of square icons called "apps" which are located in rows and columns once the iPad is turned on. [Figure 3 1] Th e iPad, has the ability to orientate its view to landscape mode to give the user more screen real estate to work with. The iPad comes with built in Bluetooth capabilities to communicate with other Bluetooth devices as well as built in Wi Fi capabilities. F inally, the iPad has a built in lithium ion polymer battery which can last up to 1 month on stand by. The iPad has one of the most intuitive user interfaces by allowing users to simply tap the screen to register an action. Because of it's flexibility as a portable device and its "plug and play" interface design, the iPad is the perfect medium to host an application that is targeted to senior citizens. After user testing the application with several elderly participants, [Se e Section 4 User testing] I found their average time to select an answer in the quiz (correct or incorrect) was around 3 seconds. [Figure 3 2] This indicates that people easily adapted to the controls of the device and quickly lea rned how to register an answer in the quiz. By placing the words, "tap", "press" or "push" in the question text, all of the participant's first attempts in answering a question were by taking their finger and

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2 8 tangibly pressing on the screen image. The lear ning curve for the iPad device is rather low for elderly users due to the larger screen size which allows the buttons in the quiz to be 275 x 275 pixels. Because there is no need for a mouse or third party device to run the iP ad, the room for confusion and error in my t esting was almost non existent. [8] Application Language and Workflow iOS applications are all written in objective C which is an object oriented language Objective C is a small extensive to the ANSI C language. To d evelop an iOS application, a person must download the developer kit and receive a license. This license cost s $99 and allows users to download t he developing software called X code as well as port their applications to a testing iOS device. Without this lic ense, your application cannot be submitted to Apple for review and entry which allows your app to be sold on the Apple Application Store. The Application Store (App Store) is the only way to distribute apple created iOS software. Included with the devel opin g software are Apple's custom made classes which X code recognizes as adequate Objective C objects to run their app lication. Some of these custom o bjects include "applicat ionDidBecomeActive" which I use when the application is turned back on after bein g asleep or exited. This class allows Family Connect to rescan the server/XML file for any updated questions. With prebuilt classes, Xcode and Apple make programming a little easier to create a well designed application. The layout of my application is ba sed a round three components; a view, a controller and a model. [Figure 3 4] The model contains the data for the application, such as the quiz information or images. The view then is called which displays the data from the

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29 model Finally, the controller is the agent that goes and accesses the information from the model and sends it to the view to be displayed. Specifically, my application starts by calling an application delegate which is the initializer for the application to lo ad. Here the app delegate searches the server for an XML file of questions generated by the website, as well as search es the application for a pre existing SQLite database of quiz results If this is the first time the application is in use, it creates a fresh database with zero entries else it appends the existing database with the new question answers Once the application receives the data from the Internet it sends it to a parsing agent which chops up the XML document into manageable pieces of data. Several of the attributes that become separate by the parser are, "Question text", "Image URL", "Image Gender", "Question Number", etc. From here, the individual parts of the question are sent to a questi on store which momentarily hold the data until it i s later called. From here, the controller pushes the view to a "Splash View" which contains the main menu. [Figure 3 5] [Figure 3 6] This menu simply acts as a train station, allowing the user to either en ter the quiz or go into the settings menu. The main functionality of the application occurs in the Main Quiz View Controller which communicates and interacts with nearly every area of the application. [Figure 3 7] With in this UIVi ew, the application calls the question store and asks for each individual question at a time. [Figure 3 8] That data is then displayed on the screen and allows the user to select them by assigning the correct pictures to a randomly selected button. [Figure 3 9] At the same time, the "Quiz Controller" calls another store filled with incorrect question images. This store populates

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30 the three remain ing but tons in t he quiz by sending them to the v iew to be displ ayed The first quiz question has now been created. Once the first question has been loaded, a hidden timer starts to take a count of how long the person takes on each question. In addition the quiz view references the s ettings view controller and finds out the difficulty settings that the administrator has selected. The difficulty selected tells the quiz which incorrect pictures to populate next to the correct one by searching the image predicates. [Figure 3 10] An image predicat e allows the computer to sort images by race, gender, hair color or age. The more difficult the setting, the more closely the incorrect images will resemble the correct one. Once the question is populated and answered, several variables are stored into th e application s database. The database is different from the application stores in that the database is contained in a single SQLite file and stay with the application forever unless deleted. The store information is not as permanent as the d atabase entri es. The database is built around Xcode s Core Data foundation. Core Data is a n easy to use solution for creating entities in a database. In figure 3 10 you can see how Family Connect organizes its database with entities and attributes. [Figure 3 11] Each quiz taken becomes an entity. Each entity has attributes such as, incorrect Score ", quiz ID or overall Difficulty". The datab ase allows the user to easily call any entity such as quiz ID and will then display that entity's attributes in a nice scrolling table. Once the quiz is completed, Core Data logs the answers into the database and the view c ontrol ler takes the user back to the splash v iew (the main menu). Afterward, the results can be viewed in the settings menu and br oken down by sorting the attributes through predicates. Again, a predicate simply tells the searching function to

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31 find objects that meet certain criteria, such as "Scored Correctly" or "Gender". In addition, after every quiz is taken, the application uses a free Xcode extension called ASIFormDataRequest which allows the SQLite data base file to be sent to a server for backup. From here the server can take that d atabase and populate an online view that breaks down the results so that family members and doct ors can stay informed The application is fairly simple in that it is constantly receiving and sharing data with a server by using a model, a view and a controller. This allows each application user to have a unique experience by viewing meaningful conte nt specific to them. Server Language and Workflow The application is constantly interacting with the server running a PHP script PHP is defined as "a server side scripting language designed for web development." [9] PHP is one of the most popular forms of web development and is installed on more than 20 million websites. PHP allows for websites that were once static to now become dynamic and receive data from online participants. The application 's website is hoste d by host ed.me wh ich allows PHP scripts to be run unlike plaza.ufl.edu. At timdifato.host ed.me/thesis/index.php a person can go an d find out information about the iPad application Here the family member would upload a picture and tag all of the m eta data that describes the picture, such as gender and age. [Figure 3 12] The PHP script then takes that information and generates an XML document which lists all of the questions and image informat ion [Figure 3 13] If any errors occur during the upload, the PHP will notify the user by posting an error message to the website. [Figure 3 14]

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32 On c e the picture is uploaded, it is neatly organized on th e server under a folder labeled "pictures". Once the iPad application is turned on, the app delegate will search the server pictures folder to grab the images. This is the entire workflow of the application and server. A PHP script allows users to upload p ictures to the server and makes an XML document which the iPad parses to receive all of the data. Finally the iPad sends back a database file of all the participants' results, which get saved to the server. [Figure 3 15] User In terface Design A major element to the success of any application is its user interface design. The mechanics of an application can be perfect, but if the design does not compliment the mechanics by allowing a simple workflow and ease of use, then all of t he programming is useless. This task is especially important for elderly people due to the higher probability of visual impairment and disabilities compared to the younger iPad users Special attention must be given to the application's color scheme, butto n layout font s and object size. Due to impaired vision, elderly people need interactive buttons to be two times the size of regular buttons, as well as contrasting colors. Dick Stroud, expert designer from OMD Marketing suggests that all design layouts f or elderly people should have dark er background s preferably tones from the bottom half of the hue circle compared to the lighter interactive foreground elements These darker backgrounds are best complimented with light foreground elements such as white silhouettes and outlined text. In addition, when creating text it is best to have "spacing between lines be at least 25 30% of the text size. The larger the font the smalle r the text leading needs to be. [10]

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33 With this in mind, I created several Family Connect designs and tested them on several participants at different ages to find out how functional the design aesthetics were. Figur e 3 15 shows the three sample designs, which range from lighter to darker background tones and slig htly differing fonts. [Figure 3 16] ( Sample 1 Dark Blue Sample 2 Lite Blue Sample Three Lite Green ) The most popular design for people 55 and unde r was sample 3, "Lite Green" [Figure 3 16c] but people 55 and over found sample 1, "Dark Blue" [Figure 3 16a] to be a b etter fit. The younger participants were more interested in the pastel color schem e and hidden aesthetic elements while people over 65 were more interested in utility and ease of use. Elderly people enjoyed the dark blue background of sample 1 compared to sample 3 because the gree n background did not give enough of a contrast between t h e foreground texts Several noted that the color of the text in the opening screen for sample 3 was a bit confusing. [Figure 3 17] The opening screen is shown while the application loads the data from the Internet The main menu was designed to be as simple as possible seeing as elderly people with Alzheimer's disease are the ones who will use and initiate the quiz. The design idea was taken from the first dropbox.com home page which had one button that said, start dropbox. [Figue 3 18] It was clean and user friend ly. In the bottom corner of Family Connect's main men u, there are 2 common iOS icons to allow a person to navigate to the settings menu or refresh the page Rather than giving these elements large buttons and recognizable text, I wanted them to be hidden. The reason these items are blend ed into the background is so that the patient using the application does not use them. Thes e are simply for the caregiver to monitor progress.

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34 All of the back ground elements and buttons were created in Adobe Illustrator because of illustrator's ability to create vector art, which can be stretched without losing quality. This way, I was able to resize the objects I needed without making images or buttons pixelat ed. The user testing is still in progress, but I believe I am on the right track with highly contrasting background and foreground elements with bold large text for users to see. Future Improvements Currently, the application is in working condition wi th multiple people actively testing the app, but this is simply my first iteration. There is always room for improvement. The first improvement would be the optimization of the parsing engine. Currently, the application grabs the entire XML document and pa rses all of the questions and images ever given and puts them into memory. This can result in a long application load time and can detract from the user experience. A future solution would be to dynamically parse five questions at a t ime and as the quiz ad vances, the application parse s the next questions in line. Possible future aesthetic improvements might be a progress bar to show how long the application needs to load. In a previous version of Family Connect, after the quiz was completed there was not a ny indication that the person finished the quiz; it simply went back to the main menu. After early user testing, a participant wanted some kind of reward for taking the quiz, which is why I implemented an encouragement page after co mpletion of the quiz. Us er feed back is an on going process and is vital to any product design.

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35 Another possible addition would be to add a sound element to the quiz by letting family members record their voices when submitting a question online for the iOS user to hear when tak ing the quiz. Several user testing participants noted that the use of stories and familiar sounds showed great results in their loved ones memory recall. By allowing family members to shape a question by telling a familiar story to help remind the patient of the speaker's image would greatly improve the experience During user testing, [See Section 4 User testing] o ne woman believed that a person's personality type before being diagnosed with AD would affect how they hand led their disease. How does a person who lived with an extroverted personality type handle having to lean on others and trust in their decision making compared to a person who lived a more passive lifestyle before AD? Does this have an affect on how the pe rson behaves or how the disease matures psychologically or is there no correlation? Thi s would be a great question to pu rsue as it could lead to vital information how to treat people with different personality types, rather than having a generic caregiver solution She suggested having a section in the quiz for a spouse to quantify the patient s prior personality type. For example, on a scale of 1 10, how independent was your loved one prior to Alzheimer's. I believe this is a tremendous feature to add whi ch would allow the doctors and researchers the ability to look into new areas of Alzheimer's treatment An obvious future step of development would be to graphically display the test results of a participant online. In addition, each family would have ind ividual account, which would privately store their information and pictures. With that said, I would have

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36 to build a login solution for the application. As of right now, the application is built for one user.

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37 Figure 3 1 An image of the iPad user interface. Each application shown by a 72x 72 pixel icon.

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38 Figure 3 2 Results of user testing from a group of 3 participants. This shows the time it took them to complete each question as well as the average question time of 3.7 seconds. Figure 3 3 Shows the breakdown of the individual question results. This information can be found inside the Family Connect 's s ettings page. Here you can see where the individual question timer records the data for Figure 3 2.

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39 Figure 3 4 Shows the work flow of iOS programs. Highlights how the three components of an application work together, View, Controller, Model.

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40 Figure 3 5 Shows Family Connect's Main Menu. Here the participant can click the big button "Tap Here to Begin" to start the quiz. The bottom right orange button refreshes the quiz The tools button goes to the s ettings menu.

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41 Figure 3 6 Shows the splashview.m file Displays the IBAction to start the quiz. Figure 3 7 (below) S hows the quiz.m file. Here we see the steps the quiz take s when loading. It resets the answers from previous quizzes, sets the ID, loads the question, randomly shuffles the 4 images for the question and then assigns them to the buttons.

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42 Figure 3 8 S hows the quiz calling the TDQuestionStore to grab all the q uestions. Once the array of questions is called, the computer displays the first object in that array, i.e. Question #1. This also show s the computer grabbing the incorrect images from the ImageStore. Figure 3 9 S hows the quiz taking the 3 incorrect images ("randomPictureOne", "Two" and "Three") as well as the correct image and putting them into an array called mixQuestions. This allows the questions to be randomly shuffled and assigned to buttons. This way, the images do not show up on the same butto n every time the quiz is taken. You also see the correct image attributes being added to theTDAnswer Store which allows it to be saved once the quiz is complete d (i.e. the image's gender, race, image URL, hair and name.)

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43 Figur e 3 10 Shows the quiz finding the difficulty settings. If it is set to "1" in the se ttings, it will grab all of the images from the incorrect image Store and sort only the ones that match the correct image s "Race" and "Gender" If there are no images that match, it reduces th e settings by "1" and grabs all the incorrect image s In this case, "medium" would drop to "easy" if there were no attribute matches.

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44 Figure 3 11 S hows the quiz entity that has eight attributes. In addition, every q uestion answered become s an entity saved in Core Data and it too has several individual attributes.

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45 Figure 3 12 Shows the website where you can submit questi ons and images to the iPad app. Click here to visit page: http://timdifato.host ed.me/thesis/submitquestion.php Figure 3 13 Shows the XML document created by entering information and uploading image s to the website. This is what the application reads every time it loads.

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46 Figure 3 14 S hows the PHP script error which is revealed if information on the website is not entered in correctly. Figure 3 15 S hows the server. Here you can see the database file being stored, (FamilyConnect.sqlite) as well as all of the .php files to run the web site.

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47 Figure 3 16 a Shows Sample 1, "Dark Blue" design for the application.

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48 Figure 3 16 b. Shows Sample 2, "Lite Blue" design for the application.

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49 Figure 3 16 c. Shows Sample 3, "Lite Green" design for the application.

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50 Fig ur e 3 17 Shows the opening load screen for sample 2, "Lite Blue" design. Figure 3 18 Shows the first Dropbox.com homepage design.

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51 CHAPTER 4 MARKET ING RESEARCH Market Demand Today, an estimate d 5.4 million America ns are living with Alzheimer's d iseas e with that number estimated to increase by 10 million more people in response to the aging of the baby boomer generation. In America, every 68 seconds a person develops Alzheimer's disease. [11] Currently, AD is one of the top lea ding killers in the United States, coming in as the sixth leading cause of death to the general population and the fifth leading cause of death for those ages 65 and up. In recent years, the majority of serious diseases, other than AD, that lead to death h ave dropped significantly, where as AD related deaths have risen. The Alzheimer's Association reports that deaths due to heart disease, stroke and prostate cancer have all been reduced by "13%, 20%, and 8%, respectively, where as the proportion due to AD i ncreased by 66%," [11] between the years of 2000 2008. [Figure 4 1] The market for an Alzheimer's disease solution is enormous and increasing. Currently, there are few non medical solutions to combat AD a nd even fewer drug related solu tions. The 2012 expected cost of AD healthcare, hospice care and long term care totals $200 billion which does not account for the estimated 17.4 billion unpaid family member hours used to care for loved ones. Medically, the United States Food and Drug Administration has approved five drugs that bring temporary relief. These drugs reduce the average signs and symptoms of AD but have varying results. No drug induced treatment today changes the outcome of the disease

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52 Targe t M arket As discussed in earlier sections of this thesis, Family Connect for Alzheimer's can be used by people in a ll stages of the disease The application can be used as a preventative tool by strengthening the mind or it can be used to help combat adva nced forms of AD to help the patients who may have already forgotten their loved ones. With that said, the application's target market is patients with mild to severe Alzheimer's, specifically stages 3 7. Mid to late stages of Alzheimer's is where patien ts start to heavily rely on their caregiver One woman I interview ed stated, there were times when I would find him with his face in his hands crying and saying, why can't I think like I use to." This man was diagnosed to have stage 4 Alzheimer's. Becaus e family members do not notice most of the early stages of AD the average patient first sees a doctor around stage s 2 3. This stage of AD is the most common and most people diagnosed with AD do not live long enough to progress into the deepest stages of t he disease. The 2012 Alzheimer's Disease Facts and Figures report states that, .. people 65 and older survive an average of four to eight years after diagnosis of Alzheimer's disease." [ 12] The target areas to market this produc t would be the state of Florida, Texas and California as they have the highest mortality rate due to Alzheimer's disease as well as the highest projected percentage increase of people diagnosed with AD [Figure 4 2] [Figure 4 3] With the baby boomer generation reaching retirement, more and more people are going to be thrown into the lottery for developing Alzheimer's. Projections show that by the year 2050 there will be nearly 21 millio n Americans aged 85. This nearly

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53 quadruples the current population of people 85 and older. Currently, 2.5 million people 85 years or older have Alzheimer's disease which will increase to an estimate 3.5 million when the baby boomers reach 85. Demographically it is believed t hat women are nearly twice as likely to be diagnosed with Alzheimer's disease than men. [Figure 4 4] Similarly, African Americans and Hispanics aged 85 and above are two times more likely to be diagnosed with Alzheimer's than Cauc asians. [Figure 4 5] With that said, the 2009 census shows that the average Caucasian income was almost double that of people classified as Hispanic or Black. [13] This number would suggest that the former two races would have less disposable income at retirement and less likely to purchase the technology to use the application. But as technology continues to advance, former technology price points become reduced. Competitors Currently, there are few comp etitors in the market for Alzheimer 's solutions. Family Connect's direct c ompetitors are considered any computer based Alzheimer solution or awareness application ranging from brain strengthening quizzes to alarm reminding software. Focus App Store : Foc us App Store is a n application that educates users on certain neurological diseases. Focus App Store made by Focus Applications educates people on how certain diseases affect the body. Simply put, t he application is defined as medical educating software. I t provides animated videos to help explain complex issues,

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54 inform ing regular people about the impacts of certain diseases. The application also provides medical treatment and best practice information This application allows a free download and gets sale s once users are inside the app. Here the users can purchase disease specific modules such as stroke or Alzheimer's Focus Applications promote s their app as free medical educating software specifically for AD. Once inside the app, each module costs $9.9 9. The iTunes App Store shows several customers who rated this 1 star due to false ly advertising this product as a free application. Without paying $9.99, Focus App Store is a useless application, as it has nothing to present on its own. [Figure 4 6] Brain Map: Brain map is an application that allows users to view and discover the brain through 3D models. The app educates and brings awareness to how a disease affects the brain. It allows you to take a picture of your head and it will show you what your brain looks like on the inside. The application simply super imposes an image on top of your image taken from the devices camera. Brain Map was created by the Alzheimer's Society to help educate and bring awareness. It is a free app lication with several 5 star reviews on the iTunes store. It is solely built for the iPhone and iPad. [Figure 4 7] Alzheimer Cards The application Alzheimer Cards ", was built by Tracey Valleau, a caregiver who used flash cards to help Alzheimer's patients with their memory. Taken from the book "Simple Pleasures for Special Seniors", the app uses generic house hold images that help start conversations between people with AD and their caregivers. The app is a simple slide

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55 show of im ages such as oranges, apples, cars and other common daily objects. These images are supposed to help jog a person's mem ory by making associations with the objects in the pictures and past events. The application is only for the iOS and is priced at $1.99. It has an average review from users of 3/5 stars due to frequent crashes and lack of content. Users do appreciate the application for its ability to create conversation and add an event to the daily routine for AD patients. The problem with apps develope d by non technical professionals is that they do not send out frequent updates to match the operating system updates. Currently, this app crashes on start up because it is not compatible with newer iOS versions. [Figure 4 8] Brai ny App Brainy App is a preventative Alzheimer's application It is an app built to workout some ones mind through brain games. It is created by Alzheimer's D isease Australia and Bupa Health Foundatio n as preventive neurological disease software. This was t he first health preventative Alzheimer's application created for mobile devices It is yet to be discovered if this application truly works, but the idea is that if a person keeps their mind and heart healthy, they will have greater odds of dodging AD. The companies slogan is, a health y heart equals a health y mind. The app combines a fun, game centered mechanic to monitor and address health issues at a person 's current age. This application created a huge press following in Australia and by far is the most concise, clean and interactive application out of the list of competitors. It has had over 200,000 downloads and is ported to iOS and Android devices. This application has won several awards such as #1 Health and Lifestyle appl ication and #1 Australian a pp. The application is free and has 5 stars by users. This

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56 application's target market is 30 40 year old people who are looking for interactive, simple solutions for preventin g future neurological diseases. [Figure 4 9] It's Done It's Done! was created by a home user who wanted software to help his fath er remember certain tasks he had complete d throughout his day. The application allows for custom built events to be added to a daily checklist such as taking out the trash or check ing the mail. Once the task is completed, the participant would check it off his list. This application is a simple daily living tool. It does not aid in recovery or try to impede the affects of the disease. The application is priced at $2.99 and has not received enough downloads or ratings to be given a general rating. [Figure 4 10] What day is it? What d ay is it? is a PC based software that turns a computer monitor into a reminder board. It posts the date, a message and plays friendly music so that the patient can remember certain tasks. The application can provide a single picture at a time as a backdrop with a message such as "This is Steve". It has several modes such as slideshow, holiday and event which displays specific info the caregiver wants the patient to remember. The application is simply a computer monitor turned into a static picture frame. The application can be downloaded online at a purchase price of $ 39. [Figure 4 11]

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57 Family Connec t User Testing For a one week period, I took this application to several homes and surveyed people from a wide spectrum of ages, ranging from 20 90 years old. There were two ty pes of survey participants I took in this test. T he first survey was taken by people who agreed to take the full test which meant uploading their families pictures and questions. This group was much smaller in size, consisting of three people and they took their personalized quiz several times. The second group was given an overall general quiz, which they only took once. Each individual of the first group took the quiz on an iPad at their home. The questions and pictures were preloaded to the website. The quiz was taken in the presence of a quiz administrator to observe behavior a nd interaction with the application. After the quiz was taken, the administrator asked the individuals certain questions from a survey document. [Figure 4 12 ] The three test takers from grou p one were over 80 years old and do not have any mental disorder or disease. This test was simply to see how elderly people interact ed with the application and their response to seeing familiar faces throughout the quiz duration. The overall response was positive. Every participant nearly ace d the quiz. The button layout seemed intuitive and easy for the participants to use. They quickly understood the logic of the game and how to submit answers. The questions submitted were written with certain intent to see how participants reacted. Some wer e very impersonal and direct, "Select the picture of Steve", while other s were personal and sincere such as "Hi mom, it's me Jack. Tap the picture of me. I love you". The personal message seemed to draw a physical showing of emotion on every participant. The task

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58 of taking the quiz became enjoyable and reminiscent where as the impersonal question s were answered almost immediately with no sign of fondness. Two of the participants had used an iPad before and under stood the basics of waking up the iPad by s liding the unlock bar" to the right to be able to access the application. The other participant struggled figuring out how to use the iPad but once that user was in the application, they progressed rapidl y through the quiz due to key phrases such as, "pre ss the image" or "tap the picture" Th ey were all given the basic dark blue color scheme. [Figure 4 13] All of them said they could easily read the text and see the pictures. In addition, all of the participants knew someone with AD and gave wonderful feedback. To view the results of their testing see figure 4 14 [Figure 4 14 ] Due to time and the lack of iPad testing units, only one of the participants was given the application to use for a 1 week period while the other two were given the quiz for a 1 day period. This user is 83 years old and lives alone. The only error or bug she encountered throughout the week was remembering to p lug in the iPad to recharge the battery She managed to take the test dai l y without any errors or issues In this time period, no new images or questions were added to the quiz. One question she asked was what would happen if she took the quiz and she had to leave. This was wonderful feedback, as I never assumed a person would l eave the quiz unless finished. If a person were to leave, they could simply click the "HOME" button built into each iPad. Once they return all they have to do is reopen the Family Connect app and the quiz will pickup right where they left off. The purpos e of this test was to see if the application would run smoothly without an administrator present.

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59 The second group was composed of random ly selected people to take the quiz and compare the design styles The generic quiz that was given to the participants is programmed into the main application in case the iPad does not have Internet access to grab the personalized questions and images. The generic quiz asks about common people everyone in the United States should know such as, the Presidents of the United States. In this study, I was simply trying to find the best UI design layout for elderly people and if younger people would use this to help their grandparents with AD. The results were very interesting. As described earlier younger people chose a lighte r layout, while the older generation chose the darker one. This coincides with the research given by the OMD m arketing group that states dark layouts with lighter text are easier for elderly eyes. Images are less likely to be blown out by the backgrounds c olor and light, which makes it easier to focus on. Several constructive results showed that the buttons in my beta design were to o close in proximity and people would either accidentally hit the wrong one or it would take them a long time to look from pi cture to picture. After spacing the images, the design became much cleaner. To view the results of the seco nd study group, view figure 4 15 and figure 4 16 [Figure 4 15] [Figure 4 16] Conclusion Thou gh my user testing sample was small, I gained invaluable information. For future work in this field, I look forward to sampling a larger population to find more concrete data and evidence towards the apps design and functionality. Alzheimer's disease is a n ever growing medical issue that affects millions of lives. Doctors and

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60 researchers need large amounts of data to find patterns and implement cures while in the meantime patients and caregivers need comfort and relief. Though Family Connect for Alzheimer' s may not directly destroy the disease it is a tool to help combat Alzheimer's while bringing comfort to patient s by using familiar faces.

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61 Figure 4 1. Shows the percentage changes in selected causes of Death. [19]

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62 Figure 4 2. Shows the number of death s due to Alzheimer's sorted by State. [20]

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63 Figure 4 3. Shows the projected percentage increase of people diagnosed with AD. [21]

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64 Figure 4 4. Estimated lifetime Risks for AD by Age and Gender. [22] Figure 4 5. Proportion of AD sorted by Race. [ 23]

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65 Figure 4 6. Displays screen shots of Focus Application. Figur e 4 7. Displays screen shots of Brain Map

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66 Figure 4 8. Displays screen shots of Alzheimer Cards.

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67 Figure 4 9. Displays screen shots of Brainy App. Figure 4 10. Displays screen shots of It'sDone!

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68 Figure 4 11. Displays scr een shot of What Day is It?

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69 Figure 4 12a. Survey given to focus group 1 participants. ( Page 1/2)

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70 Figure 4 12 b. Survey given to focus group 1 participants. (Page 2/2)

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71 Figure 4 13. Shows the design style used for te sting. For pictures of the full design layout see Figure 3 15. [Figure 3 15] Figure 4 14 Results of focus group one.

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72 Figure 4 15a. Survey given to focus group 2 participants. ( Page 1/2)

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73 Figure 4 15b. Survey given t o f ocus group 2 participants. (2 /2 pages)

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74 Figure 4 16. Results of focus group two.

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75 LIST OF REFERENCES [1] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In alzheimersanddementia Retrieved March 8, 2013, from htt p://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext. [2] National Institue of Health. (June 2011). Alzheimer's Disease Genetics Fact Sheet. In National Institue on Aging Retrieved March 8, 2013, from http://www.nia.nih.gov/alzheimer s/publication/alzheimers disease genetics fact sheet 5260(12)00032 5/fulltext. [3] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.131 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [ 4 ] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.13 2 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [ 5 ] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.1 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [6] DeMarco,B. (January, 2013). Alzheimer's Readi ng Room. In Alzheimer's Patients Often Feel Abandoned Retrieved March 10, 2013, from http://www.alzheimersreadingroom.com/2012/07/Alzheimers Abandonment Fear Patient.html [7] National Guideline Clearinghouse (NGC). ( n.d.). National Guideline Clearingh ouse (NGC). In Occupational therapy practice guidelines for adults with Alzheimer's disease and related disorders Retrieved March 12, 2013, from http://www.guidelines.gov/content.aspx?id=16321#Section405 [8] Stroud,D. ( n .d.).Tips for building 50 plus f riendly web sites. In designerstalk. Retrieved March 15, 2013, from http://www.designerstalk.com/forums/attachments/help me/4059d1200496102 old people colours 50 friendly design notes200k.pdf ). [9] PHP. (2013, March 27). In Wikipedia, The Free Encyclope dia Retrieved 20:19, March 29, 2013, from http://en.wikipedia.org/w/index.php?title=PHP&oldid=547297438 [10 ] Stroud,D. ( n .d.).Tips for building 50 plus friendly web sites. In designerstalk. Retrieved March 15, 2013, from http://www.designerstalk.com/fo rums/attachments/help me/4059d1200496102 old people colours 50 friendly design notes200k.pdf ).

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76 [ 11 ] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.1 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [12] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p. 20 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [13] U.S. Census Bureau. (2009). Money Income of Families Number and Distri bution by Race and Hispanic Origin 2009 Retriev ed March 12,2013, from http://www.census.gov/compendia/statab/2012/tables/12s0695.pdf [14 ] Keller,S. (January 20, 2012). Sundo wning Retrieved March 14,2013, from http://www.webmd.com/alzheimers/guide/sundowning causes symptoms treatments [15] Davis, R. N., Massman, P. J., & Doody, R. S. (2001). Cognitive intervention in Alzheimer disease: a randomized placebo controlled study. Alzheimer Disease & Associated Disorders, 15(1), 1. [16] Davis, R. N., Massman, P. J., & Doody, R. S. (2001). Cognitive intervention in Alzheimer disease: a random ized placebo controlled study. Alzheimer Disease & Associated Disorders, 15(1), 1. [17] Cohen, G. D. (2000). Two new intergenerational interventions for Alzheimer's disease patients and families. American Journal of Alzheimer's Disease and Other Dementias 15(3), 137 142. [ 18 ] (Alzheimer's Association 2012). (n.d.). BrainTour from http://www.alz.org/braintour/tour_credits.asp [ 19 ] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.23 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [ 20] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.24 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [ 21] (Alzheimer's Association 2012). (n.d.). 2 012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.21 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext [ 22] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.17 from http://www.alzheimersanddementia.com/arti cle/S1552 5260(12)00032 5/fulltext

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77 [ 23] (Alzheimer's Association 2012). (n.d.). 2012 Alzheimer's disease facts and figures. In Alzheimers and dementia p.16 from http://www.alzheimersanddementia.com/article/S1552 5260(12)00032 5/fulltext BIOGRAPHICAL SKETCH

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78 Mr. Difato graduated from the University of Florida with his BS in Business Marketing in 2009. In 2011 he graduate with a Maste r s i n Business Entrepreneurship. He is currently pursing his Masters in Digital Arts and Science.