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Effects of the Digital App "Support, Monitoring and Reminder Technology for Mild Dementia" (SMART4MD) on People With Mild Cognitive Impairment and Their Informal Caregivers : 18-Month Multicenter Pragmatic Randomized Controlled Trial

Ghani, Zartashia LU ; Thant, Poe Eindra ; Saha, Sanjib LU orcid ; Anderberg, Peter LU ; Aparicio, Maria Quintana ; Barnestein-Fonseca, Pilar ; Cellek, Selim ; Cleries, Fermín Mayoral ; Garolera, Maite and Guerrero-Pertiñez, Gloria , et al. (2026) In Journal of Medical Internet Research 28.
Abstract

BACKGROUND: Previous research has shown that mobile health (mHealth) interventions are effective in reminding older adults with chronic conditions about health care appointments and promoting adherence to medication schedules. However, the evidence is limited by the short duration and poor quality of the interventions.

OBJECTIVE: We evaluated the effectiveness of the Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) tablet app in improving the quality of life (QoL) of people with mild cognitive impairment (PwMCI) and their caregivers through medication reminders and health care appointment alerts.

METHODS: An 18-month pragmatic randomized controlled trial was conducted in Spain and Sweden from December... (More)

BACKGROUND: Previous research has shown that mobile health (mHealth) interventions are effective in reminding older adults with chronic conditions about health care appointments and promoting adherence to medication schedules. However, the evidence is limited by the short duration and poor quality of the interventions.

OBJECTIVE: We evaluated the effectiveness of the Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) tablet app in improving the quality of life (QoL) of people with mild cognitive impairment (PwMCI) and their caregivers through medication reminders and health care appointment alerts.

METHODS: An 18-month pragmatic randomized controlled trial was conducted in Spain and Sweden from December 2017 to September 2020 and included 1078 PwMCI and their informal caregivers.

RESULTS: For PwMCI, the intervention improved the primary outcome, composite Quality of Life in Alzheimer's Disease (QoL-AD) scale, at 18 months (mean difference 0.75, 95% CI 0.07-1.42; P=.03), and a similar effect was observed at 6 months (mean difference 0.73, 95% CI 0.09-1.36; P=.02). Confirmatory secondary outcomes for PwMCI, including medication adherence (P=.12) and Mini-Mental State Examination (MMSE) score (P=.45), did not differ significantly between groups at the 18-month follow-up. Exploratory analyses showed higher total accumulated quality-adjusted life years (QALYs) at 6 months for PwMCI (mean difference 0.035, 95% CI 0.02-0.05; nominal P<.001), informal caregivers (mean difference 0.050, 95% CI 0.04-0.07; nominal P<.001), and dyads (mean difference 0.085, 95% CI 0.06-0.11; nominal P<.001). A dropout rate of approximately 40% (429/1083, 39.61%) was observed in both the intervention and control groups.

CONCLUSIONS: The SMART4MD intervention was associated with a modest improvement in PwMCI's QoL as measured by the composite QoL-AD score. Evidence for benefits among informal caregivers and dyads was less consistent and should be interpreted as exploratory. Nominally significant findings for exploratory outcomes should be interpreted with caution, as they were not adjusted for multiplicity.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13711.

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type
Contribution to journal
publication status
published
subject
keywords
Humans, Caregivers/psychology, Cognitive Dysfunction/therapy, Mobile Applications, Reminder Systems, Aged, Quality of Life, Male, Female, Telemedicine, Aged, 80 and over, Dementia, Digital Health, Sweden, Adherence Interventions, Spain
in
Journal of Medical Internet Research
volume
28
article number
e83123
publisher
JMIR Publications Inc.
external identifiers
  • pmid:42497412
ISSN
1438-8871
DOI
10.2196/83123
language
English
LU publication?
yes
additional info
©Zartashia Ghani, Poe Eindra Thant, Sanjib Saha, Peter Anderberg, Maria Quintana Aparicio, Pilar Barnestein-Fonseca, Selim Cellek, Fermín Mayoral Cleries, Maite Garolera, Gloria Guerrero-Pertiñez, Karen Hayden, Carmel Moore, Jufen Zhang, Johan Sanmartin Berglund, Johan Jarl. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 24.07.2026.
id
f675afc6-1897-4051-b22c-d2112b9c0914
date added to LUP
2026-07-28 10:31:30
date last changed
2026-07-28 10:31:30
@article{f675afc6-1897-4051-b22c-d2112b9c0914,
  abstract     = {{<p>BACKGROUND: Previous research has shown that mobile health (mHealth) interventions are effective in reminding older adults with chronic conditions about health care appointments and promoting adherence to medication schedules. However, the evidence is limited by the short duration and poor quality of the interventions.</p><p>OBJECTIVE: We evaluated the effectiveness of the Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) tablet app in improving the quality of life (QoL) of people with mild cognitive impairment (PwMCI) and their caregivers through medication reminders and health care appointment alerts.</p><p>METHODS: An 18-month pragmatic randomized controlled trial was conducted in Spain and Sweden from December 2017 to September 2020 and included 1078 PwMCI and their informal caregivers.</p><p>RESULTS: For PwMCI, the intervention improved the primary outcome, composite Quality of Life in Alzheimer's Disease (QoL-AD) scale, at 18 months (mean difference 0.75, 95% CI 0.07-1.42; P=.03), and a similar effect was observed at 6 months (mean difference 0.73, 95% CI 0.09-1.36; P=.02). Confirmatory secondary outcomes for PwMCI, including medication adherence (P=.12) and Mini-Mental State Examination (MMSE) score (P=.45), did not differ significantly between groups at the 18-month follow-up. Exploratory analyses showed higher total accumulated quality-adjusted life years (QALYs) at 6 months for PwMCI (mean difference 0.035, 95% CI 0.02-0.05; nominal P&lt;.001), informal caregivers (mean difference 0.050, 95% CI 0.04-0.07; nominal P&lt;.001), and dyads (mean difference 0.085, 95% CI 0.06-0.11; nominal P&lt;.001). A dropout rate of approximately 40% (429/1083, 39.61%) was observed in both the intervention and control groups.</p><p>CONCLUSIONS: The SMART4MD intervention was associated with a modest improvement in PwMCI's QoL as measured by the composite QoL-AD score. Evidence for benefits among informal caregivers and dyads was less consistent and should be interpreted as exploratory. Nominally significant findings for exploratory outcomes should be interpreted with caution, as they were not adjusted for multiplicity.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699.</p><p>INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13711.</p>}},
  author       = {{Ghani, Zartashia and Thant, Poe Eindra and Saha, Sanjib and Anderberg, Peter and Aparicio, Maria Quintana and Barnestein-Fonseca, Pilar and Cellek, Selim and Cleries, Fermín Mayoral and Garolera, Maite and Guerrero-Pertiñez, Gloria and Hayden, Karen and Moore, Carmel and Zhang, Jufen and Berglund, Johan Sanmartin and Jarl, Johan}},
  issn         = {{1438-8871}},
  keywords     = {{Humans; Caregivers/psychology; Cognitive Dysfunction/therapy; Mobile Applications; Reminder Systems; Aged; Quality of Life; Male; Female; Telemedicine; Aged, 80 and over; Dementia; Digital Health; Sweden; Adherence Interventions; Spain}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{JMIR Publications Inc.}},
  series       = {{Journal of Medical Internet Research}},
  title        = {{Effects of the Digital App "Support, Monitoring and Reminder Technology for Mild Dementia" (SMART4MD) on People With Mild Cognitive Impairment and Their Informal Caregivers : 18-Month Multicenter Pragmatic Randomized Controlled Trial}},
  url          = {{http://dx.doi.org/10.2196/83123}},
  doi          = {{10.2196/83123}},
  volume       = {{28}},
  year         = {{2026}},
}