The population in Europe is getting older, and consequently the number of people with dementia or mild cognitive impairment is increasing given the association of these conditions with age. It is estimated that the population with dementia will double by 2030 and triple by 2050, reaching more than 115 million individuals [1]. One of the core symptoms in mild cognitive impairment and in the early stages of dementia is memory impairment, which is a condition that is also associated with depression, sleep problems, and other behavioral symptoms [2,3]. Guaranteeing an optimal quality of life for people with these conditions remains an enormous challenge because there are no effective long-term pharmacological treatments in the majority of cases [4].

Information and communication technologies (ICTs), especially touchscreen technologies, are promising tools to increase the quality of life and cognitive function of people with dementia/mild cognitive impairment and their caregivers [5-9]. These technologies could be used to train cognitive functions, monitor health and movements, provide reminders to support memory, promote social support, improve communication with caregivers, and provide useful information about the condition. Smartphones and tablets have the advantage of not raising a stigma for the individuals that use them [10] because they are ubiquitous and used by the majority of the population, and they also represent a natural source of data for professionals and researchers [10-13]. Over 40,000 health-related apps exist but very few are specifically designed for people with dementia/mild cognitive impairment [14]. Previous studies have found barriers associated with the use of ICTs in older adults, including age and education level [15]. Likewise, barriers for the use of technology in people with dementia/mild cognitive impairment have been described, including negative attitudes toward ICTs, inaccurate perceptions of ICTs, and poor technology knowledge [16]. Although the attitudes and knowledge of ICTs and touchscreen technologies could determine the use of health apps, to the best of our knowledge, few large-sample studies  have investigated the attitude and use of these technologies in older adults, including people with dementia/mild cognitive impairment and their caregivers. Technophilia is one of the emerging concepts regarding attitudes toward technologies. One of the definitions of technophilia is the “attraction, enthusiasm of the human individual determined by the activities which involve the use of advanced technologies. It is expressed by easy adaptation to the social changes brought by technological innovations” [17].

The aim of this study was to analyze technophilia in people with dementia/mild cognitive impairment and their caregivers and to determine the sociodemographic and clinical factors associated with technophilia. Another aim was to analyze how this population uses smartphones, tablets, apps, and software to support their memory, and to identify factors associated with the use of apps to support memory. We tested the hypothesis that different sociodemographic and clinical factors in people with dementia/mild cognitive impairment and their caregivers are associated with technophilia and the use of specific apps to support memory in tablets or smartphones.

The basic characteristics of the sample of people with dementia/mild cognitive impairment are summarized in Table 1. Nearly a third of the sample were diagnosed with dementia. A total of 588 of the 1086 people with dementia/mild cognitive impairment (54.14%) used smartphones and tablets almost every day and 284 (26.15%) had never used these technologies. Only 381/1086 (35.08%) used the internet on smartphones and tablets almost every day and 470/1086 (43.28%) never used the internet on these gadgets. More than half (706/1086, 65.01%) considered themselves not at all or quite knowledgeable when it comes to using a smartphone or a tablet. A total of 106 (9.76%) had a special app or software on their mobile phone or tablet to support memory, and 669/1086 (61.60%) believed that using a mobile phone or tablet to support their memory helps them remember things. Additional information about the use of smartphones and tablets by the people with dementia/mild cognitive impairment is provided in Multimedia Appendix 1. Information about groups with high and low technophilia and groups that use or do not use specific apps or software on their mobile phone or tablet to support memory is shown in Table 1.

The basic characteristics of the caregivers are summarized in Table 2. Among the 1086 caregivers, 839 (77.26%) used touchscreen technologies almost every day, and 123 (11.33%) had never used smartphones or tablets. A total of 721 (66.39%) used the internet on smartphones and tablets almost every day, and 191 (17.59%) never used the internet on touchscreen gadgets. A total of 433 (39.87%) considered themselves not at all or quite knowledgeable when it comes to using a smartphone or a tablet. A total of 181 (16.67%) had a special app or software on their mobile phone or tablet to support their memory, and 773 (71.18%) believed that using a mobile phone or tablet to support their memory helps them to remember things. Additional information about the use of smartphones and tablets by the caregivers is provided in Multimedia Appendix 1. Information about the caregivers overall, groups with high and low technophilia, and groups that use or do not use specific apps or software on their tablet or mobile phone to support memory is shown in Table 2.

The people with dementia/mild cognitive impairment had a mean TechPH index of 2.84 (SD 0.69). The TechEnthusiasm score was 2.95 (SD 1.07) and the TechAnxiety score was 3.30 (SD 0.95). The caregivers had a TechPH index score of 3.07 (SD 0.68); the TechEnthusiasm score was 3.31 (SD 1.00) and the TechAnxiety score was 3.19 (SD 0.95). There were differences in the TechPH index between patients and caregivers (B=0.223, SE 0.030, P<.001), which remained significant after adjusting by age, gender, education level, and health status (B=0.074, SE 0.032, P=.02). There were significant differences in TechAnxiety between patients and caregivers (B=–0.120, SE 0.041, P=0.004); however, these differences were not significant after adjusting for age, gender, education level, and health status (B=–0.042, SE 0.047, P=.37). There was a significant difference in TechEnthusiasm between patients and caregivers (B=0.360, SE 0.045, P<.001), and this difference was still significant after adjusting for confounders (B=0.128, SE 0.050, P=.01). There were significant differences in the use of specifics apps or software to support memory between patients and caregivers (odds ratio [OR]=1.783, SE 0.131, P<.001); however, these differences were not significant after adjusting for confounders (OR=0.818, SE 0.167, P=.23).

In the multivariate analysis, the TechPH index in people with dementia/mild cognitive impairment was related to lower age, male gender, higher education level, living arrangement (living with children vs single), country of residence (Sweden vs Spain), depression, and health status (Table 3). In caregivers, the TechPH index was associated with lower age, male gender, higher education level, country of residence (Sweden vs Spain), lower caregiver burden, and better quality of life (Table 4). The use of specific apps or software on tablets or mobile phones to support memory was only associated with age in people with dementia/mild cognitive impairment (Table 5) and was associated with age, education level, and caregiver burden in caregivers (Table 6).

Table 4

Multivariate linear regression model^a of factors associated with technophilia in caregivers.

In people with dementia/mild cognitive impairment, technophilia was associated with less depression, better health status, as well as with sociodemographic variables. In caregivers, technophilia was associated with a better quality of life, less care burden, and other sociodemographic variables. The results of this study indicate that people with dementia/mild cognitive impairment have less technophilia than their caregivers, specifically less TechEnthusiasm, but no differences were found in TechAnxiety. The people with dementia/mild cognitive impairment used smartphones and tablets with specific apps or software to support their memory less than their caregivers, despite being a population who would benefit most from these apps. These differences are likely due to age barriers.

The use of smartphones and tablets in our study was lower than that reported in a recent study in Australia in which 91.4% of people with dementia/mild cognitive impairment reported routinely using smartphones [29]. Likewise, in other studies that included older adults and populations with cognitive impairment and dementia, attitudes toward technology were associated with factors such as age [30-32], male gender [33], higher education level [29,30,33,34], depression and negative cognitions [35], and health status [30], and variability was found between countries [36]. A correlation between the use of health apps and age has also been reported [32,37]. However, some results in other studies have not been replicated. For example, one study reported an association between cognitive functioning and the use of technologies in a cognitively impaired population [38], and another study found that women used more health apps than men [39].

The differences in technophilia between people with dementia/mild cognitive impairment and caregivers, mainly due to the lack of technology enthusiasm, could be related to dementia or mild cognitive impairment itself. In fact, other studies have found that dementia and mild cognitive impairment were related to more perceived difficulties in everyday technology use [40]. In addition, this lack of enthusiasm for technology could be related to the apathy associated with dementia and mild cognitive impairment, which is a persistent behavioral symptom [41,42]. This apathy could affect the enthusiasm toward new technologies and may be a barrier for interventions that demand learning and adaptation to the use of these technologies.

Other studies have also found that barriers to the use of ICTs and assistive technologies in older adults are due to the lack of “interest or relevance to life” and the perception of “no need” [15,43]. Indeed, these ICTs are often not designed specifically to cover the real needs of this population and they do not arouse interest. Other studies have also found that a lack of knowledge in older adults is a barrier to the use of technologies [11,16]. In addition, age was identified as one of the most critical determinants of the use of apps to support memory after adjusting for health status. This result coincides with other studies [15,30] in the general population.

Interestingly, technophilia was also strongly associated with health status and depression after adjusting for possible confounders such as gender, age, education level, and cognitive function. One longitudinal study conducted by Cotten et al [44] and other studies [45,46] have found that use of the internet and ICTs in older individuals is associated with less depression and a better quality of life, and there is some evidence that this association is mediated by loneliness and social isolation [44,45]. In conclusion, these results highlight the potential barriers of interventions for the use of ICTs, including smartphones and tablets, to improve the quality of life of people with dementia/mild cognitive impairment. The nature of the relation between use and technophilia and quality of life and mood needs to be clarified with longitudinal and experimental studies.

The use of specific apps or software to support memory was not associated with better cognitive function, better quality of life, or less depression. However, some positive results have emerged from several meta-analyses reporting that computerized cognitive training and electronic health apps are effective in improving cognition and quality of life in people with dementia/mild cognitive impairment [47,48]. This result comes from formal interventions, and the results of the present study could be due to possible confounders not assessed in the study or because the participants were not using the apps or software adequately (eg, insufficient training time or not using well-designed apps). Other studies have also indicated inconsistencies and lack evidence regarding the effectiveness of ICT interventions to improve cognition and other health-related variables [49,50].

The results of this study need to be considered in the context of several limitations. This was a cross-sectional study, and therefore the causal relation of the variables could not be established. More longitudinal and interventional studies are necessary to determine the effects of ICT use and the attitudes toward technology in people with dementia/mild cognitive impairment and their caregivers and to identify the factors that influence these variables in the other direction. In addition, this was a secondary analysis from a clinical trial, and the sample may not be representative of all people with dementia/mild cognitive impairment and caregivers. Individuals with severe depression were excluded and more than half of the sample was from only one country. There was no established cut-off point for the definition of high or low technophilia, which limits the use of the mean as the cutoff. Another limitation is that only a small set of variables was assessed. However, the strength of the study is the large sample used with more than 2000 individuals.

In conclusion, the factors associated with technophilia suggest potential barriers to technological interventions in people with dementia/mild cognitive impairment and their caregivers. These results have implications on the possible usefulness of considering technophilia and enthusiasm toward ICTs as determinants and moderator elements in digital interventions in the elderly population. The results suggest that designers of apps for older adults with cognitive impairment should create apps that engage users and are designed specifically for their needs as this population frequently lacks enthusiasm for technology. The use of touchscreen technologies was also frequent among people with dementia/mild cognitive impairment, whereas the use of specific apps or software to support memory was reduced in people with dementia/mild cognitive impairment and caregivers, and they face age barriers for the use of these apps. However, the majority of this population considers that use of smartphones or tablets is helpful for memory, which highlights the presence of a gap between the perceived potential and actual use of these technologies.

Multimedia Appendix 1

Detailed data on use of smartphones and tablets by people with dementia/mild cognitive impairment (PwD/MCI).