Dr Haley LaMonica

Dr Haley LaMonica, Early career researcher and Clinical Neuropsychologist, The University of Sydney.

Haley is an early-career researcher and practicing Clinical Neuropsychologist with 13 years of clinical experience in ageing and dementia. She has completed undergraduate and Master’s degrees in Psychology, a Ph.D. in Clinical Psychology with a specialization in Clinical Neuropsychology, and a post-doctoral fellowship in Clinical Neuropsychology. She is a Senior Clinical Neuropsychologist and the Head of eHealth at the Healthy Brain Ageing Clinic. In relation to the latter, she brings to the team expertise in novel codesign methodologies, including participatory design and user testing as well as design, development and implementation of evidence-based, clinically relevant, Web-based tools to support and enhance mental health, cognition, and wellbeing in diverse populations, including older adults and veterans. Relative to opportunity, Haley's track record includes both research and clinical expertise in adult psychopathology, dementia prevention, neuropsychological assessment, differential diagnosis of dementia, codesign methodologies, and health information technologies.

Forefront Group :

  • BMC Healthy Brain Ageing Research group

Neurodegeneration of interest:

  • Ageing
  • Mild Cognitive Impairment
  • Alzheimer’s disease

Expertise:

  • Neuropsychological assessment
  • Differential diagnosis of dementia
  • Health information technologies

Specific Skills:

  • Registered Psychologist with Area of Practice Endorsement in Clinical Neuropsychology (Psychology Board of Australia)
  • Board Approved Supervisor (Psychology Board of Australia)
  • Board Certified Clinical Neuropsychologist (American Academy of Clinical Neuropsychology)
  • Licensed Clinical Psychologist (Massachusetts Board of Registration of Psychologists)

Project - CogNet: Developing and evaluating an online Healthy Brain Ageing psychoeducation and cognitive training intervention for older adults with Mild Cognitive Impairment

Research Project Abstract

Cognitive training (CT) has been shown to be efficacious in healthy older adults and those with Mild Cognitive Impairment (MCI), with the most robust cognitive improvements seen in memory. CT is particularly promising as a non-pharmacological therapeutic approach for those identified as being ‘at-risk’ for developing dementia. Health information technologies are increasingly recognised for their potential to provide innovative solutions to improve access to and delivery of interventions targeting dementia risk factors. Our group-based, multifaceted psychoeducation and CT program is highly acceptable and effective for improving cognition and psychological wellbeing in >450 ‘at risk’ older adults. This program has now been adapted to a Web-based format, henceforth referred to as CogNet. We are actively recruiting (throughout 2020) English speaking older adults aged ≥50 years with MCI from the community nationwide for this trial to evaluate the efficacy, feasibility and acceptability of CogNet. Outcomes include improvements in cognition, efficacy in relation to lifestyle factors and personal wellbeing, feasibility and compliance. By refining and evaluating our group-based intervention for Web-based delivery to participants at home, we will vastly increase accessibility and suitability of this therapeutic program targeting modifiable risk factors for cognitive decline.

Challenges within the field

Given the enormous financial, healthcare and community costs of living with dementia and without any cure, it is essential to focus on developing and evaluating effective interventions to delay cognitive decline and ultimately, reduce dementia incidence, targeting those older adults in preclinical phases such as Mild Cognitive Impairment. Data from the Healthy Brain Ageing Program indicates that Internet use is pervasive among older adults, with 93% of our respondents having access to the Internet in the home. Importantly, 95% of respondents were interested in a website to support healthy brain ageing. Health information technologies are popular as a low-cost, widely accessible, scalable and effective means of intervention delivery, including for the purposes of dementia risk reduction.

Research Project Description

Study Rationale

The Healthy Brain Ageing (HBA) team has successfully implemented a multi-faceted HBA intervention for cognition and psychosocial wellbeing in over 450 older adults to-date, including those with Mild Cognitive Impairment (MCI), late-life depression, and Parkinson’s disease. Our combined program of psychoeducation targeting modifiable risk factors for cognitive decline (e.g. depression, anxiety, sleep disturbance, diet, exercise, vascular risk factors), strategy-based cognitive training, and computer-based cognitive exercises has been shown to improve learning, memory, mood, sleep quality and knowledge regarding risk factors for cognitive decline (Diamond et al., 2015; Norrie et al., 2011). Our program has also consistently shown excellent adherence rates of approximately 80%. Although clearly effective, thus far we have only been able to offer our HBA intervention to those participants who a) could physically access our specialised facility and staff; and b) were agreeable to participate in a group-based intervention.

We now seek to evaluate a Web-based intervention program for ‘at risk’ older adults, comprising psychoeducation, cognitive training and therapeutic techniques targeting modifiable risk factors as well as cognition. This intervention, henceforth referred to as CogNet, is engaging, accessible and interactive. We aim to evaluate (via a randomized controlled trial) the efficacy, feasibility and acceptability of CogNet in a group of older adults with MCI, recruited from the community.

Participant Assessment Procedures

Eligible participants, as determined by a telephone screening process, will complete pre- and post-intervention online self-report questionnaires relating to medical, psychiatric, psychosocial and day-to-day functioning as well as online neuropsychological assessment using a web-based testing platform.

Treatment Arms

Intervention arm
Following randomisation, participants in the intervention arm will receive access to the CogNet website. Participants will then log in to the CogNet website via a home (or community-based, e.g. library) computer for 60-90 minutes twice per week for six weeks, to complete 12 modules in total (2 per week for 6 weeks). Two new modules will become available for access each week throughout the intervention period. Participants will be encouraged to progress through the modules in order; however, the modules will become available weekly regardless of whether the individual has completed each of the previous modules. Each module will provide participants with current, evidence-based psychoeducation as well as examples and practical instruction on a variety of strategies targeting cognition (e.g. chunking, PQRST technique, strategic diary use, structured problem solving etc.), as well as recommendations for management of mood disturbance or lifestyle factors known to affect cognition and psychosocial wellbeing.

Waitlist control arm
Participants allocated to the waitlist control condition will undergo a six-week period of treatment as usual, with weekly standardised emails from the research team containing simple tips for healthy brain ageing. After completing the follow-up assessments, the control participants will be offered the opportunity to complete the online CogNet program if they would like to do so.

Research Objectives

To evaluate the:

  • Efficacy of CogNet in relation to cognitive performance;
  • Efficacy of CogNet in relation to lifestyle factors and personal wellbeing;
  • Feasibility of a the CogNet intervention for dementia risk reduction based on the ability to meet recruitment targets; and
  • Compliance and uptake operationalised as completion of 9 of the 12 CogNet modules.

Outcomes include:

  • Cognitive performance as assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB);
  • Self-reported memory functioning and cognitive complaints;
  • Self-reported lifestyle factors and personal wellbeing, including mood, daily functioning, quality of life, and drug and alcohol use;
  • Program compliance determined by the number of sessions completed; and
  • Self-reported program acceptability and satisfaction.

Key Publications from this project

  • LaMonica, H. M., Mowszowski, L., Turner, A. & Naismith, S. L. (2019, October). CogNet: an online Healthy Brain Ageing psychoeducation and cognitive training intervention for older adults with Mild Cognitive Impairment. Oral presentation at the International Research Network on Dementia Prevention Conference, Sydney, Australia.

Infographic / Medical Diagram / Scientific Diagram / Picture

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Key Findings

Recruitment is ongoing.

Project - Developing and evaluating novel, Web-based, gamified cognitive assessments for older adults

Research Project Abstract

Emerging evidence highlights the potential benefits of assessing cognition digitally rather than using traditional, paper and pencil neuropsychological tests. The reliability of a single, lengthy (>4 hours), face-to-face assessment can vary as a result of stress, sleep quality, and mood as well as the variable ecological validity of the tests themselves. In contrast, it has been shown that brief and frequent cognitive assessments (i.e. burst testing) delivered via a smartphone demonstrate excellent reliability and validity in community-dwelling older adults, suggesting they may be sensitive to neurodegeneration in preclinical dementia. Therefore, in this study, we are developing gamified mobile cognitive tests to asses and track cognition in older adults, with the aim being able to detect the earliest signs of cognitive decline, thus facilitating therapeutic intervention.

Challenges within the field

Preclinical dementia occurs 10-20 years before symptoms first present clinically, preceding subjective cognitive impairment, objective evidence of cognitive decline, and functional changes. The gold standard neuropsychological tests typically used in clinical practice lack sensitivity to the subtle cognitive changes associated with preclinical dementia. Thus, there is an urgent need to develop more sensitive cognitive assessments, particularly in memory and executive functioning, to detect the earliest signs of cognitive decline and thus facilitate therapeutic intervention.

Research Project Description

Study Rationale

Emerging evidence highlights the potential benefits of assessing cognition digitally rather than using traditional, paper and pencil neuropsychological tests. The reliability of a single, lengthy (>4 hours), face-to-face assessment can vary as a result of stress, sleep quality, and mood as well as the variable ecological validity of the tests themselves (Chaytor et al., 2003). In contrast, it has been shown that brief and frequent cognitive assessments (i.e. burst testing) delivered via a smartphone demonstrate excellent reliability and validity in community-dwelling older adults, suggesting they may be sensitive to neurodegeneration in preclinical dementia (Hassenstab et al., 2018). Digital tools, such as a digitizing pen, extend data capture to include features of an individual’s approach to a given task (e.g. pen strokes, organisational strategies, and hesitations) as well as deficits in efficiency and information processing (Alzforum, 2017). While digitizing tests may facilitate reliable assessments outside of the clinic setting, web-based tests remain flawed as they are often boring and repetitive, thus leading to participant disengagement and discontinuation (Lumsden et al., 2016).

Applying Gaming Principles to Personal Health and Wellbeing

The ability of mobile digital games to achieve player bases numbering millions of people (Coutrot et al., 2018) points to the engaging properties of digital games and their usefulness for research and assessment. As older adults aged ≥65 are the fastest growing segment of digital game players in Australia (Brand et al., 2018), applying game design principles to cognitive tasks seems practical, particularly for brief, frequent cognitive assessments. A systematic review of gamified cognitive assessment and training paradigms also found evidence suggestive of associated improvements in engagement, intrinsic motivation, and training outcomes (when relevant) (Lumsden et al., 2016; Savulich et al., 2019). In addition to promoting repeated engagement, gamifying cognitive tasks can improve usability, decrease test anxiety, and increase ecological validity. If done carefully, beneficial outcomes of applying game design principles, can be achieved without invalidating the gamified cognitive tasks.

Methodology and Timelines

Development of cognitive assessment tasks (in process): Novel digital assessment measures are currently under development, including tests of processing speed and cognitive inhibition, using a traditional Stroop paradigm, as well as measures of verbal and visual learning and memory.

User testing (mid-to-late 2020): Three iterative cycles of one-on-one, 90-minute, ‘think-aloud’ user testing sessions will be conducted face-to-face with 15 community-dwelling adults aged 50-80 years, with five from each decade, to gather qualitative data for collation and knowledge translation in collaboration with software designers. Each cycle will test successive iterations of the paradigms that will be refined following end user feedback. Participants will also be asked to answer brief self-report questionnaires about usability and meaningfulness when completing the cognitive assessments. Furthermore, analytic data relating to the visual behaviour of users (i.e. swipes, clicks, pages viewed, etc.) will also be collected during this phase.

Research translation and future projects:

If preliminary data shows these assessments to be an effective means of assessing and tracking cognition in older adults, we will leverage additional funding for more rigorous assessment of their potential effectiveness (reliability, validity, sensitivity, specificity, etc.) relative to both gold standard neuropsychological tests and well-established web-based cognitive assessments, via the Healthy Brain Ageing Clinic, which recruits approximately 120 older adults (≥50 years) annually for a comprehensive neuropsychological and medical assessment. Additionally, the applicability of the tests across other potential user groups (e.g. testing for suicidal thoughts and behaviours, and common mental illnesses such as anxiety and depression, thus aligning with expertise of the Black Dog Institute) will be explored.

Research Objectives

We aim to develop three, Web-based, gamified versions of cognitive tests, with the intention of building lightweight and flexible paradigms that can be deployed across multiple platforms. Specifically, we aim to:

  • develop gamified mobile cognitive tests to assess and track cognition in older adults;
  • pilot, evaluate and refine these tests according to user feedback collected via three iterative cycles of user testing with the target end user population (i.e. older adults); and
  • conduct preliminary analyses of user behaviour via heatmaps (e.g. clicks, taps, scrolling behaviour collected via online analytics tools) to investigate factors associated with user motivation, engagement, and compliance.

Outcomes include:

  • the delivery of easily accessible, cost-effective, and engaging tests of cognition that can be completed routinely at home via the Internet, and
  • qualitiative and quantitiative feedback from user testing sessions to inform ongoing development and refinement of the gamified cognitive tests to detect the earliest signs of cognitive decline.

Key Publications from this project

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Infographic / Medical Diagram / Scientific Diagram / Picture

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Key Findings

Development is underway.