ETSI TR 103 349 V1.1.1 (2016-12)

Human Factors (HF); Functional needs of people with cognitive disabilities when using mobile ICT devices for an improved user experience in mobile ICT devices

DTR/HF-00151

General Information

• Status: Published
• Publication Date: 01-Dec-2016
• Technical Committee: HF - Human Factors
• Current Stage: 12 - Completion
• Due Date: 13-Dec-2016
• Completion Date: 02-Dec-2016

Standards Content (Sample)

TECHNICAL REPORT
Human Factors (HF);
Functional needs of people with cognitive disabilities
when using mobile ICT devices for an improved user
experience in mobile ICT devices

2 ETSI TR 103 349 V1.1.1 (2016-12)

Reference
DTR/HF-00151
Keywords
accessibility, ageing, cognitive, disability, ICT, inclusive design,
mobile, usability, usage needs
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3 ETSI TR 103 349 V1.1.1 (2016-12)
Contents
Contents . 3
Intellectual Property Rights . 5
Foreword. 5
Modal verbs terminology . 5
Introduction and how to use the present document . 5
1 Scope . 6
2 References . 6
2.1 Normative references . 6
2.2 Informative references . 6
3 Definitions and abbreviations . 9
3.1 Definitions . 9
3.2 Abbreviations . 9
4 Background and approach . 10
5 Cognitive impairments and diagnoses . 11
5.1 Introduction. 11
5.2 Dementia and Alzheimer fact sheet . 11
5.3 Intellectual impairments fact sheet . 14
5.4 Aphasia fact sheet . 15
5.5 Speech and Language Impairments fact sheet . 15
5.6 Autism Disorder fact sheet . 17
5.7 Attention Deficit/Hyperactivity Disorder fact sheet . 19
5.8 Dyslexia fact sheet . 20
5.9 Dyscalculia fact sheet . 21
6 Classification of usage needs when using mobile ICT . 21
6.1 Introduction. 21
6.2 List of usage needs . 21
6.3 Attention-related usage needs . 23
6.3.1 Introduction . 23
6.3.2 Focusing attention: usage with limited ability to focus attention . 24
6.3.3 Directing attention: usage with limited ability to direct attention . 24
6.3.4 Shifting attention: usage with limited ability to shift attention . 24
6.4 Reading-related usage needs . 25
6.4.1 Introduction . 25
6.4.2 Reading: usage with no ability to read . 26
6.4.3 Recognising written language: usage with limited ability to recognize written language . 26
6.4.4 Comprehending written language: usage with limited ability to comprehend written language . 26
6.5 Writing-related usage needs . 27
6.5.1 Introduction . 27
6.5.2 Writing: usage with no ability to write . 28
6.5.3 Writing correctly: usage with limited ability to correctly write words and use punctuation . 28
6.5.4 Producing written language: usage with limited ability to produce written language . 28
6.6 Calculating-related usage needs . 29
6.6.1 Introduction . 29
6.6.2 Calculating: usage with no ability to calculate . 30
6.6.3 Understanding simple maths: usage with limited ability to understand simple mathematical concepts . 30
6.7 Decision making-related usage needs . 30
6.7.1 Introduction . 30
6.7.2 Making choices: usage with limited ability to make a choice among options. 31
6.7.3 Interpreting effects of choices: usage with limited ability to interpret the effects of choices taken . 32
6.8 Usage needs related to undertaking tasks . 32
6.8.1 Introduction . 32
6.8.2 Initiating a task: usage with limited ability to initiate a task . 37
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4 ETSI TR 103 349 V1.1.1 (2016-12)
6.8.3 Organising for a task: usage with limited ability to get organised time for a task . 37
6.8.4 Carrying out a task: usage with limited ability to carry out a task . 37
6.8.5 Completing a task: usage with limited ability to complete a task . 38
6.8.6 Managing time: usage with limited ability to manage time . 38
6.8.7 Adapting to time demands: usage with limited ability to adapt to time related events and tasks . 38
6.9 Usage needs related to receiving speech . 39
6.9.1 Introduction . 39
6.9.2 Receiving spoken language: usage with no ability to receive spoken language . 39
6.9.3 Understanding spoken language: usage with limited ability to understand spoken language . 40
6.10 Usage needs related to receiving non-verbal messages . 40
6.10.1 Introduction . 40
6.10.2 Understanding body gestures: usage with limited or no ability to understand body gestures . 41
6.10.3 Understanding symbols: usage with limited or no ability to understand symbols . 41
6.10.4 Understanding drawings and photographs: usage with limited or no ability to understand drawings
and photographs . 42
6.11 Usage needs related to speaking . 42
6.11.1 Introduction . 42
6.11.2 Speaking: usage with limited or no ability to speak . 42
6.12 Usage needs related to producing non-verbal messages . 43
6.12.1 Introduction . 43
6.12.2 Producing gestures: usage with limited or no ability to produce gestures . 43
6.13 Usage needs related to memory . 44
6.13.1 Introduction . 44
6.13.2 Recalling from short-term memory: usage with limited ability to produce short-term memory . 45
6.13.3 Recalling from long-term memory: usage with limited long-term memory. 45
6.14 Usage needs related to using communication devices and techniques. 45
Annex A: ICF-related cognitive activities and functions . 47
A.1 Introduction. 47
A.2 Cognitive-related activities . 47
A.2.1 Introduction . 47
A.2.2 Learning and applying knowledge . 47
A.2.3 General tasks and demands . 48
A.2.4 Communication . 49
A.3 Cognitive-related functions . 50
A.3.1 Introduction . 50
A.3.2 Global mental functions . 50
A.3.3 Specific mental functions . 51
Annex B: Bibliography . 53
History . 54

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5 ETSI TR 103 349 V1.1.1 (2016-12)
Intellectual Property Rights
IPRs essential or potentially essential to the present document may have been declared to ETSI. The information
pertaining to these essential IPRs, if any, is publicly available for ETSI members and non-members, and can be found
in ETSI SR 000 314: "Intellectual Property Rights (IPRs); Essential, or potentially Essential, IPRs notified to ETSI in
respect of ETSI standards", which is available from the ETSI Secretariat. Latest updates are available on the ETSI Web
server (https://ipr.etsi.org/).
Pursuant to the ETSI IPR Policy, no investigation, including IPR searches, has been carried out by ETSI. No guarantee
can be given as to the existence of other IPRs not referenced in ETSI SR 000 314 (or the updates on the ETSI Web
server) which are, or may be, or may become, essential to the present document.
Foreword
This Technical Report (TR) has been produced by ETSI Technical Committee Human Factors (HF).
Modal verbs terminology
In the present document "should", "should not", "may", "need not", "will", "will not", "can" and "cannot" are to be
interpreted as described in clause 3.2 of the ETSI Drafting Rules (Verbal forms for the expression of provisions).
"must" and "must not" are NOT allowed in ETSI deliverables except when used in direct citation.
Introduction and how to use the present document
Individuals with cognitive impairments can benefit significantly with the proper use of ICT mobile devices; however,
they can face many challenges when using mobile ICT devices and their applications.
Although there are significant publications (from standardisation bodies as well as from published research) that
examine the functional needs of people with physical and sensory impairments on the use of Mobile ICT, there is very
limited relevant work on the needs of people with cognitive impairments.
In this respect, the present document aims to describe the functional needs of people with limited cognitive, language
and learning abilities in effectively using mobile ICT devices. Research studies and scientific papers along with
familiarisation with the cognitive impairments form the basis for identifying relevant usage needs.
The present document contains design guidelines for mobile devices and applications that will enable persons with
limited cognitive, language and learning abilities (e.g. people with age-related cognitive impairments) to have an
improved user experience when using mobile ICT devices and applications. The usage needs in the present document
complement already identified usage needs such as those in documents in the references clause.
The present document supplements ETSI EG 203 350: "Guidelines for the design of mobile ICT devices and their
related applications for people with cognitive disabilities" [i.1] that contains design guidelines for mobile devices and
applications that will enable persons with cognitive impairments to have an improved user experience when using
mobile ICT devices and applications.

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6 ETSI TR 103 349 V1.1.1 (2016-12)
1 Scope
The present document contains a classification and analysis of usage needs of persons with limited cognitive, language
and learning abilities (generically and historically referred to as "cognitive impairments"). It describes their functional
needs for an improved user experience when using mobile ICT devices and applications.
The present document is the basis for the development of design guidelines for mobile ICT devices and applications
ETSI EG 203 350: "Human Factors (HF); Guidelines for the design of mobile ICT devices and their related applications
for people with cognitive disabilities" [i.1] that enables people with cognitive impairments to obtain the maximum
benefit from the use of mobile ICT.
2 References
2.1 Normative references
Normative references are not applicable in the present document.
2.2 Informative references
References are either specific (identified by date of publication and/or edition number or version number) or
non-specific. For specific references, only the cited version applies. For non-specific references, the latest version of the
referenced document (including any amendments) applies.
NOTE: While any hyperlinks included in this clause were valid at the time of publication, ETSI cannot guarantee
their long term validity.
The following referenced documents are not necessary for the application of the present document but they assist the
user with regard to a particular subject area.
[i.1] ETSI EG 203 350: "Human Factors (HF); Guidelines for the design of mobile ICT devices and
their related applications for people with cognitive disabilities".
[i.2] Alzheimer Disease, National Institute on Aging, Alzheimer's Disease Education and Referral
Center.
NOTE: Available at www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet.
[i.3] Alzheimer's Association. (2014). 2014 Alzheimer's disease facts and figures. Alzheimer's &
Dementia, 10(2), e47-e92.
[i.4] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders
(DSM-5®). American Psychiatric Pub.
[i.5] American Speech-Language-Hearing Association, Aphasia.
NOTE: Available at
www.asha.org/PRPSpecificTopic.aspx?folderid=8589934663§ion=Incidence_and_Prevalence.
[i.6] American Speech-Language-Hearing Association, Childhood Fluency Disorders.
NOTE: Available at
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935336§ion=Incidence_and_Prevalence.
[i.7] American Speech-Language-Hearing Association, Social Communication Disorders in School -
Age Children.
NOTE: Available at
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934980§ion=Incidence_and_Prevalence.
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7 ETSI TR 103 349 V1.1.1 (2016-12)
[i.8] American Speech-Language-Hearing Association: Speech Sound Disorders-Articulation and
Phonology.
NOTE: Available at
http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935321§ion=Incidence_and_Prevalence.
[i.9] Braddock, D.; Rizzolo, M.; Thompson, M.; Bell, R. Emerging Technologies and Cognitive
Disability. Journal of Special Education Technology, 19 (4), 2004. pp. 49-56.
[i.10] Bölte, S., de Schipper, E., Robison, J. E., Wong, V. C.N., Selb, M., Singhal, N., de Vries, P. J. and
Zwaigenbaum, L. (2014), Classification of Functioning and Impairment: The Development of ICF
Core Sets for Autism Spectrum Disorder. Autism Res, 7: 167-172. doi: 10.1002/aur.1335.
[i.11] Burke, M. (2013). Development of a core set for aphasia using the International Classification of
Functioning, Disability and Health (ICF) (Order No. 1541098). Available from ProQuest
Dissertations & Theses Global. (1418261949). Retrieved from
http://search.proquest.com/docview/1418261949?accountid=15299.
[i.12] de Schipper, E., Lundequist, A., Coghill, D., de Vries, P. J., Granlund, M., Holtmann, M., Jonsson,
U., Karande, S., Robison, J. E., Shulman, C., Singhal, N., Tonge, B., Wong, V. C.N.,
Zwaigenbaum, L. and Bölte, S. (2015), Ability and Disability in Autism Spectrum Disorder: A
Systematic Literature Review Employing the International Classification of Functioning,
Disability and Health-Children and Youth Version. Autism Res. doi: 10.1002/aur.1485.
[i.13] ETSI EN 301 549: "Accessibility requirements suitable for public procurement of ICT products
and services in Europe".
[i.14] ETSI EG 201 013: "Human Factors (HF); Definitions, abbreviations and symbols".
[i.15] Gan, S. M., Tung, L. C., Yeh, C. H., Chang, H. Y., & Wang, C. H. (2013). The ICF-CY-based
structural equation model of factors associated with participation in children with autism.
Developmental neurorehabilitation, 17(1), 24-33.
[i.16] Gan, S. M., Tung, L. C., Yeh, C. Y., & Wang, C. H. (2013). ICF-CY based assessment tool for
children with autism. Disability and rehabilitation, 35(8), 678-685.
[i.17] International Statistical Classification of Diseases and Related Health Problems 10th Revision -
ICD-10 Version:2016.
NOTE: Available at http://apps.who.int/classifications/icd10/browse/2016/en.
[i.18] International Dyslexia Association, Dyslexia Basics.
NOTE: Available at http://eida.org/dyslexia-basics/.
[i.19] ISO/IEC TR 29138-1:2009 "Information technology - Accessibility considerations for people with
disabilities -Part 1:User needs summary".
[i.20] Mayo Clinic, Diseases and Conditions, Down Syndrome.
NOTE: Available at www.mayoclinic.org/diseases-conditions/down-syndrome/basics/symptoms/con-20020948.
[i.21] McCormack, J., & Worrall, L. E. (2008). The ICF Body Functions and Structures related to
speech-language pathology. International journal of speech-language pathology, 10(1-2), 9-17.
[i.22] National Institute of Neurological Disorders and Stroke, Autism Spectrum Disorder fact sheet.
NOTE: Available at www.ninds.nih.gov/disorders/autism/detail_autism.htm.
[i.23] National Resource Center on AD HD, "About ADHD".
NOTE: Available at http://www.chadd.org/Understanding-ADHD/About-ADHD.aspx.
[i.24] OECD Centre for Educational Research and Innovation - CERI - Dyscalculia Primer and Resource
Guide.
NOTE: Available at http://www.oecd.org/edu/ceri/dyscalculiaprimerandresourceguide.htm.
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8 ETSI TR 103 349 V1.1.1 (2016-12)
[i.25] Riva, S., Antonietti, A., The Application of the ICF Model in specific learning difficulties: A Case
Study, Psychology of Language and Communication 2010, Vol. 14 No. 2, pp. 37-58.
[i.26] Rowland, C., Fried-Oken, M., Steiner, S. A., Lollar, D., Phelps, R., Simeonsson, R. J., &
Granlund, M. (2012). Developing the ICF-CY for AAC profile and code set for children who rely
on AAC. Augmentative and Alternative Communication, 28(1), 21-32.
[i.27] Scherer, M. J., Federici, S., Tiberio, L., Pigliautile, M., Corradi, F., & Meloni, F. (2012). ICF core
set for matching older adults with dementia and technology. Ageing International, 37(4), 414-440.
[i.28] Söderström, S., Pettersson, R., Edlund-Söderström, K., Ganse, G., Holmkvist, E., Westin, O., &
Haglund, L. (2014). Development of a Swedish Comprehensive International Classification of
Functioning, Disability and Health (ICF) Core Set for adult patients with attention-deficit
hyperactivity disorder (ADHD). Nordic journal of psychiatry, 68(3), 161-168.
[i.29] U.S. Department of Health & Human Services National Institutes of Health National Institute on
Deafness and other Communicatin Disorders, Fact Sheet Aphasia.
NOTE: Available at https://www.nidcd.nih.gov/sites/default/files/Documents/health/voice/Aphasia6-1-16.pdf.
[i.30] WHO Fact sheet Nr. 362, March 2015, Dementia.
NOTE: Available at www.who.int/mediacentre/factsheets/fs362/en/.
[i.31] WHO Genes and Chromosomal diseases, Down Syndrome.
NOTE: Available at www.who.int/genomics/public/geneticdiseases/en/index1.html.
[i.32] World Health Organization. (2007). International classification of functioning, disability and
health: children & youth version: ICF-CY. World Health Organization.
[i.33] Intellectual Disability Factsheet, The American Psychiatric Association, APA 2013.
[i.34] American Association of Intellectual and Developmental Disabilities: "Definition of Intellectual
Disability".
NOTE: Available at https://aaidd.org/intellectual-disability/definition#.V0tZvpN97Ur.
[i.35] World Health Organization (2001). The World Health Report 2001 - Mental Health: New
Understanding, New Hope. Geneva: 178 pp.
[i.36] Special Olympics - Policy Paper, Health, Well-Being and Opportunity for people with Intellectual
Disability, Global Imperative, "Status and Prospects of Persons with Intellectual Disability.
NOTE: Available at
http://www.specialolympics.org/uploadedFiles/LandingPage/WhatWeDo/Research_Studies_Desciption_
Pages/Policy_Paper_Status_Prospects.pdf.
[i.37] What's the Difference Between a Speech Impairment and a Language Disorder by Ellen Koslo.
NOTE: Available at https://www.understood.org/en/learning-attention-issues/child-learning-
disabilities/communication-disorders/difference-between-speech-impairment-and-language-disorder.
[i.38] Maja Nørgård Jacobsen M.Sc., Carolyn Ha M.A. & Carla Sharp Ph.D. (2015) A Mentalization-
Based Treatment Approach to Caring for Youth in Foster Care, Journal of Infant, Child, and
Adolescent Psychotherapy, 14:4, 440-454, DOI: 10.1080/15289168.2015.1093921.
NOTE: Available at http://dx.doi.org/10.1080/15289168.2015.1093921.
[i.39] The Next Big Thing In Design? Less Choice.
NOTE: Available at https://www.fastcodesign.com/3045039/the-next-big-thing-in-design-fewer-choices.
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9 ETSI TR 103 349 V1.1.1 (2016-12)
3 Definitions and abbreviations
3.1 Definitions
For the purposes of the present document, the terms and definitions given in ETSI EG 201 013 [i.14] and the following
apply:
activity: execution of a task or action by an individual
NOTE: Sources: [i.35].
activity limitation: difficulty an individual may have in executing an activity
NOTE: Sources: [i.35].
body function: physiological function of body systems (including psychological systems)
NOTE: Sources: [i.35].
cognitive disability: activity limitations or participation restrictions that occur when factors in the environment contain
barriers for persons with cognitive impairments
cognitive impairment: substantial limitation in person's capacity to think, including conceptualizing, planning, and
sequencing thoughts and actions, remembering, interpreting subtle social cues, and understanding numbers and symbols
NOTE: Sources: [i.9].
Information and Communication Technology (ICT): technology, equipment, or interconnected system or subsystem
of equipment for which the principal function is the creation, conversion, duplication, automatic acquisition, storage,
analysis, evaluation, manipulation, management, movement, control, display, switching, interchange, transmission,
reception, or broadcast of data or information
NOTE: Examples of ICT are electronic content, telecommunications products, computers and ancillary
equipment, software, information kiosks and transaction machines, videos, IT services, and multifunction
office machines which copy, scan, and fax documents.
mobile ICT: ICT that uses mobile technologies
NOTE: Mobile technologies include, but are not limited to, mobile phones, smartphones, tablets, smart watches
and services accessed through these devices.
participation restriction: problem an individual may have in involvement in life situations
NOTE: Sources: [i.35].
usage need: specific support needed by an individual to overcome an activity limitation
NOTE 1: Defining usage needs from activities allows a "design for all" approach to be followed, as the usage needs
are based on supporting users doing activities they have trouble with (reading, speaking, organising, etc.)
without the need to consider the reasons (the impairments or diagnoses) for those limitations.
NOTE 2: The usage needs in the present document are those that are relevant when individuals are interacting with
mobile ICT.
3.2 Abbreviations
For the purposes of the present document, the following abbreviations apply:
ADHD Attention-Deficit/Hyperactivity Disorder
APA American Psychiatric Association
ASD Autism Spectrum Disorder
DfA Design for All
DSM Diagnostic and Statistical Manual
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10 ETSI TR 103 349 V1.1.1 (2016-12)
ICD International Classification of Diseases
ICD-10 International Classification of Diseases 10th Revision
ICF International Classification of Functioning, Disability and Health
ICF-CY International Classification of Functioning, Disability and Health for Children and Youth
ICT Information and Communication Technology
LD Learning Disability
MCI Mild Cognitive Impairment
WHO World Health Organization
4 Background and approach
The present document uses a standards-based approach for defining cognitive impairments and usage needs.
Two major sources of information have been used for identifying the major cognitive impairments: the International
th
Statistical Classification of Diseases and Related Health Problems 10 Revision (ICD-10) [i.17], from the World Health
Organization (WHO) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [i.4] from the American
Psychiatric Association (APA). Both documents include information about cognitive impairments, as part of a wider
collection of mental and behavioural disorders and impairments.
The first step involved the definition and selection of a subset of cognitive impairments based on scientific literature
and on two criteria. The first criterion is prevalence, that is, how many individuals have a particular cognitive
impairment. The second one is potential use and benefits, that is, whether persons having a particular cognitive
impairment can use mobile technologies, with the support of the required assistive technologies. Based on this
approach, the following cognitive impairments have been defined and selected:
 Dementia and Alzheimer's disease
 Intellectual impairments including Down syndrome
 Aphasia
 Speech and Language Impairments
 Autism
 Attention-Deficit/Hyperactivity Disorder - ADHD
 Dyslexia
 Dyscalculia
The second step was to relate and describe further the identified cognitive impairments mainly based on the activities
(execution of tasks or actions by an individual) and if necessary - but also limited - on body functions (physiological
functions of body systems, including psychological ones) by using the vocabulary of the WHO ICF-CY, the
International classification of functioning, disability and health, children and youth version [i.35].
A broad range of ICF activities and functions was derived from the cognitive impairments listed above. However, it is
not only persons who have these cognitive impairments that experience limitations in relation to these activities or
impairments in the functions. Similar limitations and impairments may be experienced by most people in situations of
high stress or cognitive overload (e.g. when attempting to multi-task). This means that any guidelines derived from the
usage needs described in the present document are likely to be of benefit to a much wider range of people and situations
than those directly associated with the cognitive impairments and diagnoses listed above.
The third step was to define a new set of usage needs that are based on the related ICF activities and in some cases also
on ICF functions. The outcomes from this step are described in clause 6.
NOTE 1: Defining usage needs from activities allows a "design for all" approach to be followed, as the usage needs
are based on supporting users doing activities they have trouble with (reading, speaking, organising, etc.)
without the need to consider the reasons (the impairments or diagnoses) for those limitations.
NOTE 2: The approach applied in the present document is to identify activities that are relevant when individuals
are interacting with mobile ICT, and then to define usage needs for those activities.
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11 ETSI TR 103 349 V1.1.1 (2016-12)
NOTE 3: In some cases, it may be necessary to refer in addition to ICF functions, either because there is no relevant
ICF activity (as it is the case with memory) or because the functions can provide additional details to
activities (as is the case with attention).
NOTE 4: Each usage need has a unique identifier to enable cross-referencing.
5 Cognitive impairments and diagnoses
5.1 Introduction
Clause 5 outlines the nine selected cognitive impairments that fall within the scope of the present document and resulted
mainly from the first two steps in the approach. Each relevant cognitive impairment is outlined in a table in a form of a
"fact sheet".
5.2 Dementia and Alzheimer fact sheet
Table 1: Dementia and Alzheimer's disease fact sheet
Name of disorder Dementia and Alzheimer's disease
DSM-5 Classification [i.4] Dementia: Neurodevelopmental Disorders (31)/Intellectual Disabilities (33)
Alzheimer's disease: Neurocognitive Disorders (591)/ Major or Mild
Neurocognitive Disorder Due to Alzheimer's disease (611)
ICD-10 Classification [i.17] Dementia:
 F00 Dementia in Alzheimer disease
 F01 Vascular Dementia
 F02 Dementia in other diseases classified elsewhere
 F03 Unspecified dementia
Alzheimer's disease:
 G30 Alzheimer disease
Description Dementia:
Dementia is a syndrome in which there is deterioration in memory, thinking,
behaviour and the ability to perform everyday activities.
Although dementia mainly affects older people, it is not a normal part of ageing.
Alzheimer's disease is the most common cause of dementia and may
contribute to 60 - 70 % of cases.
Dementia is one of the major causes of disability and dependency among older
people worldwide.
It affects memory, thinking, orientation, comprehension, calculation, learning
capacity, language, and judgment. Consciousness is not affected.

Dementia is caused by a variety of diseases and injuries that primarily or
secondarily affect the brain, such as Alzheimer's disease or stroke.
It is one of the major causes of disability and dependency among older people
worldwide. It is overwhelming not only for the people who have it, but also for
their caregivers and families.
Sources: [i.30]
Diagnosis/Main symptoms Dementia Signs and symptoms:
The symptoms linked to dementia can be understood in three stages.

Early stage: forgetfulness, losing track of the time, becoming lost in familiar
places.
Middle stage: becoming forgetful of recent events and people's names,
becoming lost at home, having increasing difficulty with communication,
needing help with personal care, experiencing behaviour changes, including
wandering and repeated questioning.

Late stage: becoming unaware of the time and place, having difficulty
recognizing relatives and friends, having an increasing need for assisted self-
care, having difficulty walking, experiencing behaviour changes that may
escalate and include aggression.

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Name of disorder Dementia and Alzheimer's disease
Common forms:
Alzheimer's disease is the most common form of dementia and may contribute
to 60 % - 70 % of cases
Sources: [i.30]
Alzheimer's disease signs and symptoms:
First symptoms
For many, decline in non-memory aspects of cognition, such as word-finding,
vision/spatial issues, and impaired reasoning or judgment, may signal the very
early stages of Alzheimer's disease.

Mild Alzheimer's disease:
As Alzheimer's disease progresses, people experience greater memory loss
and other cognitive difficulties. Problems can include wandering and getting
lost, trouble handling money and paying bills, repeating questions, taking longer
to complete normal daily tasks, and personality and behaviour changes.

Moderate Alzheimer's disease:
Memory loss and confusion grow worse, and people begin to have problems
recognizing family and friends.
They may be unable to learn new things, carry out multistep tasks such as
getting dressed, or cope with new situations. In addition, people at this stage
may have hallucinations, delusions and paranoia, and may behave impulsively.

Severe Alzheimer's disease:
People with severe Alzheimer's cannot communicate and are completely
dependent on others for their care.
Sources:
[i.2] and [i.3]
Prevalence- How many people are Dementia:
affected? Worldwide, 47,5 million people have dementia and there are 7,7 million new
cases every year, with just over half (58 %) living in low- and middle-income
countries. Every year, there are 7,7 million new cases.

The estimated proportion of the general population aged 60 and over with
dementia at a given time is between 5 to 8 per 100 people.

The total number of people with dementia is projected to 75,6 million in 2030
and almost triple by 2050 to 135,5 million.
Sources: [i.30].
Alzheimer's disease:
The prevalence of overall dementia rises steeply with age. In high-income
countries, it ranges from 5 % to 10 % in the seventh decade to at least 25 %
thereafter. The percentage of dementias attributable to Alzheimer's disease
ranges from about 60 % to over 90 %, depending on the setting and diagnostic
criteria. Mild dementia due to Alzheimer's disease is likely to represent a
substantial fraction of Mild Cognitive Impairment (MCI) as well.
Sources: [i.2] and [i.3]
Potential use and benefits Dementia and Alzheimer's disease:
If in a late phase of the disease, people become too unfocused and forgetful,
they may not be able to actively use mobile technology or take in information
presented from an electronic device. They may, however, benefit indirectly from
the passive use of such devices, e.g. for location and communication purposes
(help button, "baby phone" functionality).

In all phases of the disease, people benefit from using mobile technologies, e.g.
for reminding them of regular or special events or for leading them home if they
get lost. Mobile technology may also support caregivers.
ETSI
13 ETSI TR 103 349 V1.1.1 (2016-12)
Name of disorder Dementia and Alzheimer's disease
Related ICF Activities and Learning and Applying Knowledge: d110 Watching, d115 Listening, d130
Participation, Sources: [i.35] and [i.26] Copying, d135 Rehearsing, d1550 Acquiring basic skills, d1551 Acquiring
complex skills,d160 Focusing attention, d163 Thinking, d166 Reading, d170
Writing, d172 Calculating, d175 Solving Problems, d1750 Solving simple
problems, d1751 Solving complex problems, d177 Making decisions.

General Tasks and Demands: d210 Undertaking a single task, d2100
Undertaking a simple task, d2101 Undertaking a complex task, d2102
Undertaking a single task independently, d2103 Undertaking a single task in a
group, d220 Undertaking multiple tasks, d2200 Carrying out multiple tasks,
d2201 Completing multiple tasks, d2202 Undertaking multiple tasks
independently, d2203 Undertaking multiple tasks in a group, d230 Carrying out
daily routine, d2301 Managing daily routine, d2302 Completing the daily
routine, d2303 Managing one's own activity level.

Communication: d310 Communicating with - receiving - spoken messages,
d315 Communicating with - receiving - nonverbal messages, d3150
Communicating with - receiving - body gestures, d3151 Communicating with -
receiving - general signs and symbols, d3152 Communicating with - receiving -
drawings and photographs, d325 Communicating with - receiving - written
messages, d330 Speaking, d335 Producing nonverbal messages, d3350
Producing body language, d3351 Producing signs and symbols, d3352
Producing drawings and photographs, d345 Writing messages, d3500 Starting
a conversation, d3501 Sustaining a conversation, d3502 Ending a
conversation, d3503 Conversing with one person, d3504 Conversing with many
people, d355 Discussion, d3550 Discussion with one person, d3551 Discussion
with many people, d360 Using communication devices and techniques.

Mobility: d440 Fine hand use (picking up, grasping).
Additional ICF Body Functions for Mental Functions: b140 Attention functions, b1400 Sustaining attention,
complimenting ICF Activities. Sources: b1401 Shifting attention, b1402 Dividing attention, b144 Memory functions,
[i.35] and [i.27] b1440 Short-term memory, b1441 Long-term memory, b1442 Retrieval of
memory.
NOTE: The description of dementia says that it involves problems in almost all cognitive functions: memory, language,
thinking, orientation, calculating, communicating, etc. For this reason the list of ICF items related to dementia
includes so many functions and activities.

ETSI
14 ETSI TR 103 349 V1.1.1 (2016-12)
5.3 Intellectual impairments fact sheet
Table 2: Intellectual Impairments (including Down S
...