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Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024; 404:572-628. [PMID: 39096926 DOI: 10.1016/s0140-6736(24)01296-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia; University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, VIC, Australia
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Nick C Fox
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Cleusa P Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura N Gitlin
- College of Nursing and Health Professions, AgeWell Collaboratory, Drexel University, Philadelphia, PA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Division of Psychiatry, University College London, London, UK; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Noeline Nakasujja
- Department of Psychiatry College of Health Sciences, Makerere University College of Health Sciences, Makerere University, Kampala City, Uganda
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Kokoro Shirai
- Graduate School of Social and Environmental Medicine, Osaka University, Osaka, Japan
| | - Archana Singh-Manoux
- Division of Psychiatry, University College London, London, UK; Université Paris Cité, Inserm U1153, Paris, France
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Yao Yao
- China Center for Health Development Studies, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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2
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Saavedra-Mitjans M, Van der Maren S, Gosselin N, Duclos C, Frenette AJ, Arbour C, Burry L, Williams V, Bernard F, Williamson DR. Use of actigraphy for monitoring agitation and rest-activity cycles in patients with acute traumatic brain injury in the ICU. Brain Inj 2024; 38:692-698. [PMID: 38635547 DOI: 10.1080/02699052.2024.2341323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND In traumatic brain injury patients (TBI) admitted to the intensive care unit (ICU), agitation can lead to accidental removal of catheters, devices as well as self-extubation and falls. Actigraphy could be a potential tool to continuously monitor agitation. The objectives of this study were to assess the feasibility of monitoring agitation with actigraphs and to compare activity levels in agitated and non-agitated critically ill TBI patients. METHODS Actigraphs were placed on patients' wrists; 24-hour monitoring was continued until ICU discharge or limitation of therapeutic efforts. Feasibility was assessed by actigraphy recording duration and missing activity count per day. RESULTS Data from 25 patients were analyzed. The mean number of completed day of actigraphy per patient was 6.5 ± 5.1. The mean missing activity count was 20.3 minutes (±81.7) per day. The mean level of activity measured by raw actigraphy counts per minute over 24 hours was higher in participants with agitation than without agitation. CONCLUSIONS This study supports the feasibility of actigraphy use in TBI patients in the ICU. In the acute phase of TBI, agitated patients have higher levels of activity, confirming the potential of actigraphy to monitor agitation.
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Affiliation(s)
- Mar Saavedra-Mitjans
- Faculté de Pharmacie, Université de Montréal, Montréal (Québec), Canada
- Research Centre, Centre intégré universitaire de Santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Solenne Van der Maren
- Center for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Département de Psychologie, Université de Montréal, Montréal (Québec), Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Département de Psychologie, Université de Montréal, Montréal (Québec), Canada
| | - Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Centre intégré universitaire de santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Department of Neuroscience, Faculté de médecine, Université de Montréal, Montréal (Québec), Canada
- CIFAR Azrieli Global Scholars Program, Toronto, Canada
| | - Anne Julie Frenette
- Research Centre, Centre intégré universitaire de Santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
- Pharmacy Department, Centre intégré universitaire de santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
| | - Caroline Arbour
- Faculté de Pharmacie, Université de Montréal, Montréal (Québec), Canada
- Faculté de Sciences Infirmières, Université de Montréal, Montréal (Québec), Canada
| | - Lisa Burry
- Department of Pharmacy and Medicine, Sinai Health System, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Virginie Williams
- Faculté de Pharmacie, Université de Montréal, Montréal (Québec), Canada
| | - Francis Bernard
- Faculté de Pharmacie, Université de Montréal, Montréal (Québec), Canada
- Faculté de Médecine, Université de Montréal, Montréal (Québec), Canada
| | - David R Williamson
- Faculté de Pharmacie, Université de Montréal, Montréal (Québec), Canada
- Research Centre, Centre intégré universitaire de Santé et de Services sociaux du Nord-de-l'île-de-Montréal, Montreal, Canada
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Wong B, Wu P, Ismail Z, Watt J, Goodarzi Z. Detecting agitation and aggression in persons living with dementia: a systematic review of diagnostic accuracy. BMC Geriatr 2024; 24:559. [PMID: 38926638 PMCID: PMC11210082 DOI: 10.1186/s12877-024-05143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE 40-60% of persons living with dementia (PLWD) experience agitation and/or aggression symptoms. There is a need to understand the best method to detect agitation and/or aggression in PLWD. We aimed to identify agitation and/or aggression tools that are validated against a reference standard within the context of PLWD. METHODS Our study was registered on PROSPERO (CRD42020156708). We searched MEDLINE, Embase, and PsycINFO up to April 22, 2024. There were no language or date restrictions. Studies were included if they used any tools or questionnaires for detecting either agitation or aggression compared to a reference standard among PLWD, or any studies that compared two or more agitation and/or aggression tools in the population. All screening and data extraction were done in duplicates. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data extraction was completed in duplicates by two independent authors. We extracted demographic information, prevalence of agitation and/or aggression, and diagnostic accuracy measures. We also reported studies comparing the correlation between two or more agitation and/or aggression tools. RESULTS 6961 articles were screened across databases. Six articles reporting diagnostic accuracy measures compared to a reference standard and 30 articles reporting correlation measurements between tools were included. The agitation domain of the Spanish NPI demonstrated the highest sensitivity (100%) against the agitation subsection of the Spanish CAMDEX. Single-study evidence was found for the diagnostic accuracy of commonly used agitation scales (BEHAVE-AD, NPI and CMAI). CONCLUSIONS The agitation domain of the Spanish NPI, the NBRS, and the PAS demonstrated high sensitivities, and may be reasonable for clinical implementation. However, a limitation to this finding is that despite an extensive search, few studies with diagnostic accuracy measurements were identified. Ultimately, more research is needed to understand the diagnostic accuracy of agitation and/or aggression detection tools among PLWD.
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Affiliation(s)
- Britney Wong
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pauline Wu
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zahra Goodarzi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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Qian L, Chan A, Cai J, Lewicke J, Gregson G, Lipsett M, Rios Rincón A. Evaluation of the accuracy of a UWB tracker for in-home positioning for older adults. Med Eng Phys 2024; 126:104155. [PMID: 38621851 DOI: 10.1016/j.medengphy.2024.104155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 04/17/2024]
Abstract
The population of older adults is rapidly growing. In-home monitoring systems have been used to support aging-in-place. Ambient sensors or wearable localizers can be used but may be too low resolution, while camera systems are invasive to privacy. Ultra-wideband (UWB) localization offers precise positioning by placing anchors throughout the house and wearing a tag that is tracked by the anchors. In this study, the accuracy of UWB for indoor tracking was evaluated in a motion capture gait lab and in a mock condo in the Glenrose Rehabilitation Hospital. First, the configuration of UWB was tested, changing factors related to sampling time, anchor placement and line-of-sight. Comparing these factors to the configurations recommended by the manufacturer guidelines, accuracies remained within 14 cm. We then performed static and dynamic accuracy tests, with dynamic testing comprised of rolling and walking motions. In the motion capture lab, we found localization accuracies of 7.0 ± 11.1 cm while in the mock condo, we found accuracies of 27.3 ± 12.9 cm. Dynamic testing with rolling motions had an average of 19.1 ± 1.6 cm while walking was 20.5 ± 4.2 cm. The mean accuracy of UWB is within the 30 cm target for indoor localization.
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Affiliation(s)
- Linna Qian
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Andrew Chan
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada.
| | - Joanne Cai
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Justin Lewicke
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada
| | - Geoff Gregson
- Research, Innovation and Technology, Glenrose Rehabilitation Hospital, 10105 112 Ave NW, Edmonton, AB T5G 0H1, Canada; Department of Occupational Therapy, University of Alberta, 8205 - 114St, 2-64 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Michael Lipsett
- Department of Mechanical Engineering, University of Alberta, 10th Floor, Donadeo Innovation Centre for Engineering, 9211 116St NW, Edmonton, AB T6G 1H9, Canada
| | - Adriana Rios Rincón
- Department of Occupational Therapy, University of Alberta, 8205 - 114St, 2-64 Corbett Hall, Edmonton, AB T6G 2G4, Canada
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Xu J, Smaling HJA, Schoones JW, Achterberg WP, van der Steen JT. Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review. BMC Palliat Care 2024; 23:78. [PMID: 38515049 PMCID: PMC10956214 DOI: 10.1186/s12904-024-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Discomfort and distressing symptoms are common at the end of life, while people in this stage are often no longer able to express themselves. Technologies may aid clinicians in detecting and treating these symptoms to improve end-of-life care. This review provides an overview of noninvasive monitoring technologies that may be applied to persons with limited communication at the end of life to identify discomfort. METHODS A systematic search was performed in nine databases, and experts were consulted. Manuscripts were included if they were written in English, Dutch, German, French, Japanese or Chinese, if the monitoring technology measured discomfort or distressing symptoms, was noninvasive, could be continuously administered for 4 hours and was potentially applicable for bed-ridden people. The screening was performed by two researchers independently. Information about the technology, its clinimetrics (validity, reliability, sensitivity, specificity, responsiveness), acceptability, and feasibility were extracted. RESULTS Of the 3,414 identified manuscripts, 229 met the eligibility criteria. A variety of monitoring technologies were identified, including actigraphy, brain activity monitoring, electrocardiography, electrodermal activity monitoring, surface electromyography, incontinence sensors, multimodal systems, and noncontact monitoring systems. The main indicators of discomfort monitored by these technologies were sleep, level of consciousness, risk of pressure ulcers, urinary incontinence, agitation, and pain. For the end-of-life phase, brain activity monitors could be helpful and acceptable to monitor the level of consciousness during palliative sedation. However, no manuscripts have reported on the clinimetrics, feasibility, and acceptability of the other technologies for the end-of-life phase. CONCLUSIONS Noninvasive monitoring technologies are available to measure common symptoms at the end of life. Future research should evaluate the quality of evidence provided by existing studies and investigate the feasibility, acceptability, and usefulness of these technologies in the end-of-life setting. Guidelines for studies on healthcare technologies should be better implemented and further developed.
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Affiliation(s)
- Jingyuan Xu
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Hanneke J A Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- University Network for the Care Sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care, and Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Min D, Yu SY. Long-term Care Facility Staff's Experience of Safety Activities: A Qualitative Study. West J Nurs Res 2023; 45:1008-1016. [PMID: 37737156 DOI: 10.1177/01939459231201086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Ensuring the safety and quality of care is paramount in long-term care facilities due to residents' vulnerability. OBJECTIVE We explored the experiences of long-term care facility staff (eg, registered nurses [RNs], certified nursing assistants [CNAs], care workers, social workers, and physical therapists) in safety activities, aiming to understand their meaning and nature. METHODS We conducted qualitative focus group interviews with 25 participants, specifically addressing safety issues in long-term care facilities through the use of open-ended questions. We transcribed the data and conducted thematic analysis. RESULTS Participants engaged in discussions about various challenges, including assisting residents in maintaining physical comfort, managing behavioral and psychological symptoms of dementia, ensuring medication safety, implementing infection control practices, and providing adequate training on fire prevention, evacuation, and response protocols. Themes identified were "physical comfort," "managing dementia symptoms," "drug administration," "infection control," and "fire prevention." CONCLUSIONS The staff emphasized the safety of residents as their highest priority. Considering the lack of registered nurses in long-term care facilities, ongoing training and supervision are necessary to ensure that other long-term care facility staff can perform safety activities.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Soo-Young Yu
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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Faruk T, Shum LC, Iaboni A, Khan SS. Walking path images from real-time location data predict degree of cognitive impairment. Artif Intell Med 2023; 144:102657. [PMID: 37783548 DOI: 10.1016/j.artmed.2023.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND We propose a novel approach that uses spatial walking patterns produced by real-time location systems to classify the severity of cognitive impairment (CI) among residents of a memory care unit. METHODS Each participant was classified as "No-CI", "Mild-Moderate CI" or "Severe CI" based on their Mini-Mental State Examination scores. The location data was distributed into windows of various durations (5, 10, 15 and 30 min) and transformed into images used to train a custom convolutional neural network (CNN) at each window size. Class Activation Mapping was applied to the top-performing models to determine the features of images associated with each class. RESULTS The best performing model achieved an accuracy of 87.38 % (30-min window length) with an overall pattern that larger window sizes perform better. The class activation maps were effectively consolidated into a Cognitive Impairment Classification Value (CICV) score that distinguishes between No-CI, Mild-Moderate CI, and Severe CI. CONCLUSION The class activation maps show that the CNN made relevant and intuitive distinctions for paths corresponding to each class. Future work should validate the proposed techniques with participants who are well-characterized clinically, over larger and diversified settings, and towards classification of neuropsychiatric symptoms such as motor agitation, mood, or apathy.
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Affiliation(s)
- Tamim Faruk
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
| | - Leia C Shum
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
| | - Andrea Iaboni
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
| | - Shehroz S Khan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada.
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Rababa M, Aldrawsheh A, Hayajneh AA, Eyadat AM, Tawalbeh R. The Predictors of Negative and Positive Affect among People with Dementia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1724. [PMID: 37893441 PMCID: PMC10607976 DOI: 10.3390/medicina59101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: This cross-sectional study examined the predictors of negative and positive affect among individuals with dementia. Materials and Methods: A sample of 102 Jordanian participants diagnosed with dementia was recruited from residential care facilities, and data were collected using different measures. Results: The results revealed that higher levels of negative affect were significantly associated with increased physical and verbal agitation among individuals with dementia. Conversely, lower levels of positive affect were associated with residing in a nursing home. Conclusions: These findings highlight the importance of recognizing the impact of both negative and positive affect on the well-being of individuals with dementia. Interventions targeting the reduction of negative affect and promoting positive affect could alleviate agitation and enhance emotional closeness in this population.
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Affiliation(s)
- Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.A.H.)
| | - Ayham Aldrawsheh
- Community and Mental Health Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan (A.M.E.)
| | - Audai A. Hayajneh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.A.H.)
| | - Anwar M. Eyadat
- Community and Mental Health Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan (A.M.E.)
| | - Raghad Tawalbeh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (A.A.H.)
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Sandhu M, Prabhu D, Lu W, Kholghi M, Packer K, Higgins L, Varnfield M, Silvera-Tawil D. The Significance and Limitations of Sensor-based Agitation Detection in People Living with Dementia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083550 DOI: 10.1109/embc40787.2023.10340349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Agitation, a commonly observed behaviour in people living with dementia (PLwD), is frequently interpreted as a response to physiological, environmental, or emotional stress. Agitation has the potential to pose health risks to both individuals and their caregivers, and can contribute to increased caregiver burden and stress. Early detection of agitation can facilitate with timely intervention, which has the potential to prevent escalation to other challenging behaviors. Wearable and ambient sensors are frequently used to monitor physiological and behavioral conditions and the collected signals can be engaged to detect the onset of an agitation episode. This paper delves into the current sensor-based methods for detecting agitation in PLwD, and reviews the strengths and limitations of existing works. Future directions to enable real-time agitation detection to empower caregivers are also deliberated, with a focus on their potential to reduce caregiver burden by facilitating early support, assistance and interventions to timely manage agitation episodes in PLwD.
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Eikelboom WS, Singleton EH, van den Berg E, de Boer C, Coesmans M, Goudzwaard JA, Vijverberg EGB, Pan M, Gouw C, Mol MO, Gillissen F, Fieldhouse JLP, Pijnenburg YAL, van der Flier WM, van Swieten JC, Ossenkoppele R, Kors JA, Papma JM. The reporting of neuropsychiatric symptoms in electronic health records of individuals with Alzheimer's disease: a natural language processing study. Alzheimers Res Ther 2023; 15:94. [PMID: 37173801 PMCID: PMC10176879 DOI: 10.1186/s13195-023-01240-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in the early clinical stages of Alzheimer's disease (AD) according to proxy-based instruments. Little is known about which NPS clinicians report and whether their judgment aligns with proxy-based instruments. We used natural language processing (NLP) to classify NPS in electronic health records (EHRs) to estimate the reporting of NPS in symptomatic AD at the memory clinic according to clinicians. Next, we compared NPS as reported in EHRs and NPS reported by caregivers on the Neuropsychiatric Inventory (NPI). METHODS Two academic memory clinic cohorts were used: the Amsterdam UMC (n = 3001) and the Erasmus MC (n = 646). Patients included in these cohorts had MCI, AD dementia, or mixed AD/VaD dementia. Ten trained clinicians annotated 13 types of NPS in a randomly selected training set of n = 500 EHRs from the Amsterdam UMC cohort and in a test set of n = 250 EHRs from the Erasmus MC cohort. For each NPS, a generalized linear classifier was trained and internally and externally validated. Prevalence estimates of NPS were adjusted for the imperfect sensitivity and specificity of each classifier. Intra-individual comparison of the NPS classified in EHRs and NPS reported on the NPI were conducted in a subsample (59%). RESULTS Internal validation performance of the classifiers was excellent (AUC range: 0.81-0.91), but external validation performance decreased (AUC range: 0.51-0.93). NPS were prevalent in EHRs from the Amsterdam UMC, especially apathy (adjusted prevalence = 69.4%), anxiety (adjusted prevalence = 53.7%), aberrant motor behavior (adjusted prevalence = 47.5%), irritability (adjusted prevalence = 42.6%), and depression (adjusted prevalence = 38.5%). The ranking of NPS was similar for EHRs from the Erasmus MC, although not all classifiers obtained valid prevalence estimates due to low specificity. In both cohorts, there was minimal agreement between NPS classified in the EHRs and NPS reported on the NPI (all kappa coefficients < 0.28), with substantially more reports of NPS in EHRs than on NPI assessments. CONCLUSIONS NLP classifiers performed well in detecting a wide range of NPS in EHRs of patients with symptomatic AD visiting the memory clinic and showed that clinicians frequently reported NPS in these EHRs. Clinicians generally reported more NPS in EHRs than caregivers reported on the NPI.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Casper de Boer
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Section of Geriatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Everard G B Vijverberg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michel Pan
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Cornalijn Gouw
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Merel O Mol
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Freek Gillissen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jay L P Fieldhouse
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
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11
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Mishra PK, Iaboni A, Ye B, Newman K, Mihailidis A, Khan SS. Privacy-protecting behaviours of risk detection in people with dementia using videos. Biomed Eng Online 2023; 22:4. [PMID: 36681841 PMCID: PMC9863094 DOI: 10.1186/s12938-023-01065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People living with dementia often exhibit behavioural and psychological symptoms of dementia that can put their and others' safety at risk. Existing video surveillance systems in long-term care facilities can be used to monitor such behaviours of risk to alert the staff to prevent potential injuries or death in some cases. However, these behaviours of risk events are heterogeneous and infrequent in comparison to normal events. Moreover, analysing raw videos can also raise privacy concerns. PURPOSE In this paper, we present two novel privacy-protecting video-based anomaly detection approaches to detect behaviours of risks in people with dementia. METHODS We either extracted body pose information as skeletons or used semantic segmentation masks to replace multiple humans in the scene with their semantic boundaries. Our work differs from most existing approaches for video anomaly detection that focus on appearance-based features, which can put the privacy of a person at risk and is also susceptible to pixel-based noise, including illumination and viewing direction. We used anonymized videos of normal activities to train customized spatio-temporal convolutional autoencoders and identify behaviours of risk as anomalies. RESULTS We showed our results on a real-world study conducted in a dementia care unit with patients with dementia, containing approximately 21 h of normal activities data for training and 9 h of data containing normal and behaviours of risk events for testing. We compared our approaches with the original RGB videos and obtained a similar area under the receiver operating characteristic curve performance of 0.807 for the skeleton-based approach and 0.823 for the segmentation mask-based approach. CONCLUSIONS This is one of the first studies to incorporate privacy for the detection of behaviours of risks in people with dementia. Our research opens up new avenues to reduce injuries in long-term care homes, improve the quality of life of residents, and design privacy-aware approaches for people living in the community.
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Affiliation(s)
- Pratik K. Mishra
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrea Iaboni
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Bing Ye
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Alex Mihailidis
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Shehroz S. Khan
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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12
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Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 PMCID: PMC9745651 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
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Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
- Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
- Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
- Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
- Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada
- Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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13
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Wijbenga RA, Blaauw FJ, Janus SIM, Tibben C, Smits AE, Oude Voshaar RC, Zuidema SU, Zuidersma M. Individual differences in the temporal relationship between sleep and agitation: a single-subject study in nursing home residents with dementia experiencing sleep disturbance and agitation. Aging Ment Health 2022; 26:1669-1677. [PMID: 34129803 DOI: 10.1080/13607863.2021.1935464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Previous studies on the interrelationship between sleep and agitation relied on group-aggregates and so results may not be applicable to individuals. This proof-of-concept study presents the single-subject study design with time series analysis as a method to evaluate the association between sleep and agitation in individual nursing home residents using actigraphy. METHOD To record activity, three women and two men (aged 78-89 years) wore the MotionWatch 8© (MW8) for 9 consecutive weeks. Total sleep time and agitation were derived from the MW8 data. We performed time series analysis for each individual separately. To gain insight into the experiences with the actigraphy measurements, care staff filled out an investigator-developed questionnaire on their and participants' MW8 experiences. RESULTS A statistically significant temporal association between sleep and agitation was present in three out of five participants. More agitation was followed by more sleep for participant 1, and by less sleep for participant 4. As for participants 3 and 4, more sleep was followed by more agitation. Two-thirds of the care staff members (16/24) were positive about the use of the MW8. Acceptability of the MW8 was mixed: two residents refused to wear the MW8 thus did not participate, one participant initially experienced the MW8 as somewhat unpleasant, while four participants seemed to experience no substantial problems. CONCLUSION A single-subject approach with time series analysis can be a valuable tool to gain insight into the temporal relationship between sleep and agitation in individual nursing home residents with dementia experiencing sleep disturbance and agitation.
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Affiliation(s)
- Rianne A Wijbenga
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank J Blaauw
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Distributed Systems Group, University of Groningen, Groningen, The Netherlands
| | - Sarah I M Janus
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Coby Tibben
- Meriant, Zorggroep Alliade, Heerenveen, The Netherlands
| | - Annelies E Smits
- Zorggroep Alliade, Heerenveen, The Netherlands.,Sleep-Wake Centre SEIN, Zwolle, The Netherlands
| | - Richard C Oude Voshaar
- University Center of Psychiatry & Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marij Zuidersma
- University Center of Psychiatry & Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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14
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Oliveira R, Feres R, Barreto F, Abreu R. CNN for Elderly Wandering Prediction in Indoor Scenarios. SN COMPUTER SCIENCE 2022; 3:230. [PMID: 35465153 PMCID: PMC9019803 DOI: 10.1007/s42979-022-01091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/12/2022] [Indexed: 11/25/2022]
Abstract
This work proposes a way to detect the wandering movement of Alzheimer’s patients from path data collected from non-intrusive indoor sensors around the house. Due to the lack of adequate data, we have manually generated a dataset of 220 paths using our developed application. Wandering patterns in the literature are normally identified by visual features (such as loops or random movement), thus our dataset was transformed into images and augmented. Convolutional layers were used on the neural network model since they tend to have good results in finding patterns mainly on images. The Convolutional Neural Network model was trained with the generated data representing the hourly analysis and achieved an F1 score (relation between precision and recall) of 75%, recall of 60%, and precision of 100% on the validation slice. For comparative purposes, we have also trained the model with a 30-min interval of analysis and achieved an F1 score of 57.14%, a recall of 80% and a precision of 44.44%.
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Affiliation(s)
- Rafael Oliveira
- Centro Universitário Unilasalle do Rio de Janeiro, R. Gastão Gonçalves, 79, Niterói, Rio de Janeiro Brazil
| | - Rafael Feres
- Centro Universitário Unilasalle do Rio de Janeiro, R. Gastão Gonçalves, 79, Niterói, Rio de Janeiro Brazil
| | - Fabio Barreto
- Centro Universitário Unilasalle do Rio de Janeiro, R. Gastão Gonçalves, 79, Niterói, Rio de Janeiro Brazil
| | - Raphael Abreu
- Centro Universitário Unilasalle do Rio de Janeiro, R. Gastão Gonçalves, 79, Niterói, Rio de Janeiro Brazil
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15
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Applications and Outcomes of Internet of Things for Patients with Alzheimer’s Disease/Dementia: A Scoping Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6274185. [PMID: 35342749 PMCID: PMC8948545 DOI: 10.1155/2022/6274185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives We aimed to identify and classify the Internet of Things (IoT) technologies used for Alzheimer's disease (AD)/dementia as well as the healthcare aspects addressed by these technologies and the outcomes of the IoT interventions. Methodology. We searched PubMed/MEDLINE, IEEE Explore, Web of Science, OVID, Scopus, Embase, Cochrane, and Google Scholar. In total, 13,005 papers were reviewed, 36 of which were finally selected. All the reviews were independently carried out by two researchers. In the case of any disagreement, the problem was resolved by holding a meeting and exchanging views. Due to the diversity of the reviewed studies, narrative analysis was performed. Results Among the technologies used for the patients including radio frequency identification (RFID), near field communication (NFC), ZigBee, Bluetooth, global positioning system (GPS), sensors, and cameras, the sensors were employed in 36 studies, most of which were switch and vital sign monitoring sensors. The most common aspects of AD/dementia care monitored using these technologies were activities of daily living (ADLs) in 27 studies, followed by sleep patterns and disease diagnosis in 19 and 14 studies, respectively. Sleeping, medication, vital signs, agitation, memory, social interaction, apathy, movement, tracking, and fall were other aspects monitored by IoT. Then, their outcomes were reported. Conclusion Using IoT for AD/dementia provides many opportunities for considering various aspects of this disease. Moreover, the ability to use various technologies for gathering patient-related data provides a comprehensive application for almost all aspects of the patients' care with high accuracy.
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16
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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17
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Sikstrom L, Maslej MM, Hui K, Findlay Z, Buchman DZ, Hill SL. Conceptualising fairness: three pillars for medical algorithms and health equity. BMJ Health Care Inform 2022; 29:e100459. [PMID: 35012941 PMCID: PMC8753410 DOI: 10.1136/bmjhci-2021-100459] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Fairness is a core concept meant to grapple with different forms of discrimination and bias that emerge with advances in Artificial Intelligence (eg, machine learning, ML). Yet, claims to fairness in ML discourses are often vague and contradictory. The response to these issues within the scientific community has been technocratic. Studies either measure (mathematically) competing definitions of fairness, and/or recommend a range of governance tools (eg, fairness checklists or guiding principles). To advance efforts to operationalise fairness in medicine, we synthesised a broad range of literature. METHODS We conducted an environmental scan of English language literature on fairness from 1960-July 31, 2021. Electronic databases Medline, PubMed and Google Scholar were searched, supplemented by additional hand searches. Data from 213 selected publications were analysed using rapid framework analysis. Search and analysis were completed in two rounds: to explore previously identified issues (a priori), as well as those emerging from the analysis (de novo). RESULTS Our synthesis identified 'Three Pillars for Fairness': transparency, impartiality and inclusion. We draw on these insights to propose a multidimensional conceptual framework to guide empirical research on the operationalisation of fairness in healthcare. DISCUSSION We apply the conceptual framework generated by our synthesis to risk assessment in psychiatry as a case study. We argue that any claim to fairness must reflect critical assessment and ongoing social and political deliberation around these three pillars with a range of stakeholders, including patients. CONCLUSION We conclude by outlining areas for further research that would bolster ongoing commitments to fairness and health equity in healthcare.
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Affiliation(s)
- Laura Sikstrom
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Marta M Maslej
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katrina Hui
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Findlay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sean L Hill
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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18
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Ramsey M, Lee EE. Digital Dementia Care for the Future: Opportunities and Challenges. Am J Geriatr Psychiatry 2022; 30:12-14. [PMID: 34134922 PMCID: PMC8752056 DOI: 10.1016/j.jagp.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Marina Ramsey
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California
| | - Ellen E. Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California,Department of Psychiatry, University of California San Diego, San Diego, California,VA San Diego Healthcare System, La Jolla, California
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19
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Cheung JCW, So BPH, Ho KHM, Wong DWC, Lam AHF, Cheung DSK. Wrist accelerometry for monitoring dementia agitation behaviour in clinical settings: A scoping review. Front Psychiatry 2022; 13:913213. [PMID: 36186887 PMCID: PMC9523077 DOI: 10.3389/fpsyt.2022.913213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Agitated behaviour among elderly people with dementia is a challenge in clinical management. Wrist accelerometry could be a versatile tool for making objective, quantitative, and long-term assessments. The objective of this review was to summarise the clinical application of wrist accelerometry to agitation assessments and ways of analysing the data. Two authors independently searched the electronic databases CINAHL, PubMed, PsycInfo, EMBASE, and Web of Science. Nine (n = 9) articles were eligible for a review. Our review found a significant association between the activity levels (frequency and entropy) measured by accelerometers and the benchmark instrument of agitated behaviour. However, the performance of wrist accelerometry in identifying the occurrence of agitation episodes was unsatisfactory. Elderly people with dementia have also been monitored in existing studies by investigating the at-risk time for their agitation episodes (daytime and evening). Consideration may be given in future studies on wrist accelerometry to unifying the parameters of interest and the cut-off and measurement periods, and to using a sampling window to standardise the protocol for assessing agitated behaviour through wrist accelerometry.
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Affiliation(s)
- James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ken Hok Man Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Alan Hiu-Fung Lam
- Department of Electrical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Daphne Sze Ki Cheung
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Iaboni A, Spasojevic S, Newman K, Schindel Martin L, Wang A, Ye B, Mihailidis A, Khan SS. Wearable multimodal sensors for the detection of behavioral and psychological symptoms of dementia using personalized machine learning models. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12305. [PMID: 35496371 PMCID: PMC9043905 DOI: 10.1002/dad2.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/15/2022]
Abstract
Introduction Behavioral and psychological symptoms of dementia (BPSD) signal distress or unmet needs and present a risk to people with dementia and their caregivers. Variability in the expression of these symptoms is a barrier to the performance of digital biomarkers. The aim of this study was to use wearable multimodal sensors to develop personalized machine learning models capable of detecting individual patterns of BPSD. Methods Older adults with dementia and BPSD (n = 17) on a dementia care unit wore a wristband during waking hours for up to 8 weeks. The wristband captured motion (accelerometer) and physiological indicators (blood volume pulse, electrodermal activity, and skin temperature). Agitation or aggression events were tracked, and research staff reviewed videos to precisely annotate the sensor data. Personalized machine learning models were developed using 1‐minute intervals and classifying the presence of behavioral symptoms, and behavioral symptoms by type (motor agitation, verbal aggression, or physical aggression). Results Behavioral events were rare, representing 3.4% of the total data. Personalized models classified behavioral symptoms with a median area under the receiver operating curve (AUC) of 0.87 (range 0.64–0.95). The relative importance of the different sensor features to the predictive models varied both by individual and behavior type. Discussion Patterns of sensor data associated with BPSD are highly individualized, and future studies of the digital phenotyping of these behaviors would benefit from personalization.
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Affiliation(s)
- Andrea Iaboni
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Sofija Spasojevic
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | | | - Angel Wang
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | - Bing Ye
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Alex Mihailidis
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Shehroz S. Khan
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Institute of Biomaterials & Biomedical Engineering University of Toronto Toronto Ontario Canada
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21
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Haslam-Larmer L, Shum L, Chu CH, McGilton K, McArthur C, Flint AJ, Khan S, Iaboni A. Real-time location systems technology in the care of older adults with cognitive impairment living in residential care: A scoping review. Front Psychiatry 2022; 13:1038008. [PMID: 36440422 PMCID: PMC9685159 DOI: 10.3389/fpsyt.2022.1038008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There has been growing interest in using real-time location systems (RTLS) in residential care settings. This technology has clinical applications for locating residents within a care unit and as a nurse call system, and can also be used to gather information about movement, location, and activity over time. RTLS thus provides health data to track markers of health and wellbeing and augment healthcare decisions. To date, no reviews have examined the potential use of RTLS data in caring for older adults with cognitive impairment living in a residential care setting. OBJECTIVE This scoping review aims to explore the use of data from real-time locating systems (RTLS) technology to inform clinical measures and augment healthcare decision-making in the care of older adults with cognitive impairment who live in residential care settings. METHODS Embase (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid) and IEEE Xplore databases were searched for published English-language articles that reported the results of studies that investigated RTLS technologies in persons aged 50 years or older with cognitive impairment who were living in a residential care setting. Included studies were summarized, compared and synthesized according to the study outcomes. RESULTS A total of 27 studies were included. RTLS data were used to assess activity levels, characterization of wandering, cognition, social interaction, and to monitor a resident's health and wellbeing. These RTLS-based measures were not consistently validated against clinical measurements or clinically important outcomes, and no studies have examined their effectiveness or impact on decision-making. CONCLUSION This scoping review describes how data from RTLS technology has been used to support clinical care of older adults with dementia. Research efforts have progressed from using the data to track activity levels to, most recently, using the data to inform clinical decision-making and as a predictor of delirium. Future studies are needed to validate RTLS-based health indices and examine how these indices can be used to inform decision-making.
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Affiliation(s)
- Lynn Haslam-Larmer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Leia Shum
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Charlene H Chu
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kathy McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Shehroz Khan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health, University Health Network, Toronto, ON, Canada
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22
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Seibert K, Domhoff D, Bruch D, Schulte-Althoff M, Fürstenau D, Biessmann F, Wolf-Ostermann K. Application Scenarios for Artificial Intelligence in Nursing Care: Rapid Review. J Med Internet Res 2021; 23:e26522. [PMID: 34847057 PMCID: PMC8669587 DOI: 10.2196/26522] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background Artificial intelligence (AI) holds the promise of supporting nurses’ clinical decision-making in complex care situations or conducting tasks that are remote from direct patient interaction, such as documentation processes. There has been an increase in the research and development of AI applications for nursing care, but there is a persistent lack of an extensive overview covering the evidence base for promising application scenarios. Objective This study synthesizes literature on application scenarios for AI in nursing care settings as well as highlights adjacent aspects in the ethical, legal, and social discourse surrounding the application of AI in nursing care. Methods Following a rapid review design, PubMed, CINAHL, Association for Computing Machinery Digital Library, Institute of Electrical and Electronics Engineers Xplore, Digital Bibliography & Library Project, and Association for Information Systems Library, as well as the libraries of leading AI conferences, were searched in June 2020. Publications of original quantitative and qualitative research, systematic reviews, discussion papers, and essays on the ethical, legal, and social implications published in English were included. Eligible studies were analyzed on the basis of predetermined selection criteria. Results The titles and abstracts of 7016 publications and 704 full texts were screened, and 292 publications were included. Hospitals were the most prominent study setting, followed by independent living at home; fewer application scenarios were identified for nursing homes or home care. Most studies used machine learning algorithms, whereas expert or hybrid systems were entailed in less than every 10th publication. The application context of focusing on image and signal processing with tracking, monitoring, or the classification of activity and health followed by care coordination and communication, as well as fall detection, was the main purpose of AI applications. Few studies have reported the effects of AI applications on clinical or organizational outcomes, lacking particularly in data gathered outside laboratory conditions. In addition to technological requirements, the reporting and inclusion of certain requirements capture more overarching topics, such as data privacy, safety, and technology acceptance. Ethical, legal, and social implications reflect the discourse on technology use in health care but have mostly not been discussed in meaningful and potentially encompassing detail. Conclusions The results highlight the potential for the application of AI systems in different nursing care settings. Considering the lack of findings on the effectiveness and application of AI systems in real-world scenarios, future research should reflect on a more nursing care–specific perspective toward objectives, outcomes, and benefits. We identify that, crucially, an advancement in technological-societal discourse that surrounds the ethical and legal implications of AI applications in nursing care is a necessary next step. Further, we outline the need for greater participation among all of the stakeholders involved.
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Affiliation(s)
- Kathrin Seibert
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Domhoff
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Bruch
- Auf- und Umbruch im Gesundheitswesen UG, Bonn, Germany
| | - Matthias Schulte-Althoff
- School of Business and Economics, Department of Information Systems, Freie Universität Berlin, Einstein Center Digital Future, Berlin, Germany
| | - Daniel Fürstenau
- Department of Digitalization, Copenhagen Business School, Frederiksberg, Denmark.,Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Biessmann
- Faculty VI - Informatics and Media, Beuth University of Applied Sciences, Einstein Center Digital Future, Berlin, Germany
| | - Karin Wolf-Ostermann
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
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Gedde MH, Husebo BS, Erdal A, Puaschitz NG, Vislapuu M, Angeles RC, Berge LI. Access to and interest in assistive technology for home-dwelling people with dementia during the COVID-19 pandemic (PAN.DEM). Int Rev Psychiatry 2021; 33:404-411. [PMID: 33416012 DOI: 10.1080/09540261.2020.1845620] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The COVID-19 restrictions affect daily living in Norway, including home-dwelling people with dementia, and researchers conducting clinical trials in dementia care. In this paper, we 1) describe the development of a pandemic cohort (PAN.DEM) incorporated in the LIVE@Home.Path, an ongoing clinical intervention trial on resource utilisation including home-dwelling people with dementia and their caregivers (N = 438 dyads), 2) describe pre-pandemic use of assistive technology and 3) explore the extent to which COVID-19 restrictions increase caregivers interest in innovation in the PAN.DEM cohort (N = 126). Our main finding is that assistive technology is available to 71% pre-pandemic; the vast majority utilise traditional stove guards and safety alarms, only a few operate sensor technology, including GPS, fall detectors or communication aids. In response to COVID-19, 17% show increased interest in technology; being less familiar with operating a telephone and having higher cognitive functioning are both associated with increased interest. We conclude that wearable and sensor technology has not yet been fully implemented among people with dementia in Norway, and few caregivers show increased interest under the restrictions. Clinicaltrials.gov (NCT0404336).
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Affiliation(s)
- Marie H Gedde
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Ane Erdal
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nathalie G Puaschitz
- Centre for Care Research, Western Norway University of Applied Sciences, Bergen, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Line I Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Askoy, Norway
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A Pilot Study to Detect Agitation in People Living with Dementia Using Multi-Modal Sensors. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:342-358. [DOI: 10.1007/s41666-021-00095-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
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25
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Grigorovich A, Kontos P. Towards Responsible Implementation of Monitoring Technologies in Institutional Care. THE GERONTOLOGIST 2021; 60:1194-1201. [PMID: 31958118 PMCID: PMC7491435 DOI: 10.1093/geront/gnz190] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Increasing awareness of errors and harms in institutional care settings, combined with rapid advancements in artificial intelligence, have resulted in a widespread push for implementing monitoring technologies in institutional settings. There has been limited critical reflection in gerontology regarding the ethical, social, and policy implications of using these technologies. We critically review current scholarship regarding use of monitoring technology in institutional care, and identify key gaps in knowledge and important avenues for future research and development.
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Affiliation(s)
- Alisa Grigorovich
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada
| | - Pia Kontos
- Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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26
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Pirker-Kees A, Baumgartner C. Wearables bei Demenzerkrankungen. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1353-9371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDemenzerkrankungen führen durch den schleichenden Abbau kognitiver, sozialer und emotionaler Fähigkeiten, auch zu einem Verlust von Autonomie und Selbstbestimmtheit. Wearables sind am Körper getragene Sensoren: Akzelerometer und GPS-Tracker sind im Freizeit- und Fitnessbereich allgegenwärtig – sie zeichnen Bewegungs- und Positionsdaten auf. Das Potenzial, diese bei Demenzpatienten einzusetzen ist groß und wird intensiv beforscht. Wearables sind tlw. auch am Markt erhältlich (bspw. GPS-Tracker in Schuhsohlen). Informationen über Gangbild und Bewegungsdaten können auch Hinweise auf das Sturzrisiko, Verhaltensstörungen/Life-Events oder differenzialdiagnostische Aspekte geben. Trotz des großen Potenzials dürfen ethische Aspekte betreffend die Privatsphäre und den Datenschutz in der Entwicklung nicht außer Acht gelassen werden. Dieser Artikel gibt einen Überblick über die aktuelle Entwicklung von Wearables und damit verbundene ethische Aspekte.
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Affiliation(s)
- Agnes Pirker-Kees
- Neurologische Abteilung, Klinik Hietzing
- Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie
| | - Christoph Baumgartner
- Neurologische Abteilung, Klinik Hietzing
- Karl Landsteiner Institut für Klinische Epilepsieforschung und Kognitive Neurologie
- Medizinische Fakultät, Sigmund Freud Privatuniversität, Wien
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27
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Galvin JE, Cohen I, Greenfield KK, Walker M. The Frontal Behavioral Battery: A Measure of Frontal Lobe Symptoms in Brain Aging and Neurodegenerative Disease. J Alzheimers Dis 2021; 83:721-739. [PMID: 34366351 PMCID: PMC10731583 DOI: 10.3233/jad-210446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Approximately 90%of persons living with dementia experience behavioral symptoms, including frontal lobe features involving motivation, planning, social behavior, language, personality, mood, swallowing, and gait. OBJECTIVE We conducted a two-stage study with a development sample (n = 586) and validation sample (n = 274) to evaluate a brief informant-rated measure of non-cognitive features of frontal lobe dysfunction: the Frontal Behavioral Battery (FBB). METHODS In the development sample, internal consistency, principal factor analysis, and correlations between the FBB and outcomes were evaluated. In the validation sample, we examined (a) FBB scores by diagnosis, (b) known-group validity by demographics, subjective complaints, and dementia staging, and (c) correlation between FBB and MRI volumes. Receiver operator characteristic curves assessed the ability of the FBB to discriminate individuals with frontal lobe features due to a neurodegenerative disease. RESULTS The FBB characterized 11 distinct frontal lobe features. Individuals with dementia with Lewy bodies and frontotemporal degeneration had the greatest number of frontal lobe features. Premorbid personality traits of extroversion, agreeableness, and openness were associated with fewer frontal lobe behavioral symptoms, while subjective cognitive complaints were associated with greater symptoms. The FBB provided very good discrimination between individuals with and without cognitive impairment (diagnostic odds ratio: 13.1) and between individuals with and without prominent frontal lobe symptoms (diagnostic odds ratio: 84.8). CONCLUSION The FBB may serve as an effective and efficient method to assess the presence of non-cognitive symptoms associated with frontal lobe dysfunction, but in a brief fashion that could facilitate its use in clinical care and research.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iris Cohen
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri K. Greenfield
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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28
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Suibkitwanchai K, Sykulski AM, Perez Algorta G, Waller D, Walshe C. Nonparametric time series summary statistics for high-frequency accelerometry data from individuals with advanced dementia. PLoS One 2020; 15:e0239368. [PMID: 32976498 PMCID: PMC7518630 DOI: 10.1371/journal.pone.0239368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
Accelerometry data has been widely used to measure activity and the circadian rhythm of individuals across the health sciences, in particular with people with advanced dementia. Modern accelerometers can record continuous observations on a single individual for several days at a sampling frequency of the order of one hertz. Such rich and lengthy data sets provide new opportunities for statistical insight, but also pose challenges in selecting from a wide range of possible summary statistics, and how the calculation of such statistics should be optimally tuned and implemented. In this paper, we build on existing approaches, as well as propose new summary statistics, and detail how these should be implemented with high frequency accelerometry data. We test and validate our methods on an observed data set from 26 recordings from individuals with advanced dementia and 14 recordings from individuals without dementia. We study four metrics: Interdaily stability (IS), intradaily variability (IV), the scaling exponent from detrended fluctuation analysis (DFA), and a novel nonparametric estimator which we call the proportion of variance (PoV), which calculates the strength of the circadian rhythm using spectral density estimation. We perform a detailed analysis indicating how the time series should be optimally subsampled to calculate IV, and recommend a subsampling rate of approximately 5 minutes for the dataset that has been studied. In addition, we propose the use of the DFA scaling exponent separately for daytime and nighttime, to further separate effects between individuals. We compare the relationships between all these methods and show that they effectively capture different features of the time series.
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Affiliation(s)
- Keerati Suibkitwanchai
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
- * E-mail:
| | - Adam M. Sykulski
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | | | - Daniel Waller
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Au‐Yeung WM, Miller L, Beattie Z, Dodge HH, Reynolds C, Vahia I, Kaye J. Sensing a problem: Proof of concept for characterizing and predicting agitation. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12079. [PMID: 32864417 PMCID: PMC7443743 DOI: 10.1002/trc2.12079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Agitation, experienced by patients with dementia, is difficult to manage and stressful for caregivers. Currently, agitation is primarily assessed by caregivers or clinicians based on self-report or very brief periods of observation. This limits availability of comprehensive or sensitive enough reporting to detect early signs of agitation or identify its precipitants. The purpose of this article is to provide proof of concept for characterizing and predicting agitation using a system that continuously monitors patients' activities and living environment within memory care facilities. METHODS Continuous and unobtrusive monitoring of a participant is achieved using behavioral sensors, which include passive infrared motion sensors, door contact sensors, a wearable actigraphy device, and a bed pressure mat sensor installed in the living quarters of the participant. Environmental sensors are also used to continuously assess temperature, light, sound, and humidity. Episodes of agitation are reported by nursing staff. Data collected for 138 days were divided by 8-hour nursing shifts. Features from agitated shifts were compared to those from non-agitated shifts using t-tests. RESULTS A total of 37 episodes of agitation were reported for a male participant, aged 64 with Alzheimer's disease, living in a memory care unit. Participant activity metrics (eg, transitions within the living room, sleep scores from the bedmat, and total activity counts from the actigraph) significantly correlated with occurrences of agitation at night (P < 0.05). Environmental variables (eg, humidity) also correlated with the occurrences of agitation at night (P < 0.05). Higher activity levels were also observed in the evenings before agitated nights. DISCUSSION A platform of sensors used for unobtrusive and continuous monitoring of participants with dementia and their living space seems feasible and shows promise for characterization of episodes of agitation and identification of behavioral and environmental precipitants of agitation.
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Affiliation(s)
- Wan‐Tai M. Au‐Yeung
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- NIA‐Layton Aging & Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Lyndsey Miller
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- School of NursingOregon Health & Science UniversityPortlandOregonUSA
| | - Zachary Beattie
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- NIA‐Layton Aging & Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Hiroko H. Dodge
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- NIA‐Layton Aging & Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Christina Reynolds
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- NIA‐Layton Aging & Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Ipsit Vahia
- McLean HospitalBelmontMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey Kaye
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Oregon Center for Aging & TechnologyOregon Health & Science UniversityPortlandOregonUSA
- NIA‐Layton Aging & Alzheimer's Disease CenterOregon Health & Science UniversityPortlandOregonUSA
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Radio Signal Sensing and Signal Processing to Monitor Behavioral Symptoms in Dementia: A Case Study. Am J Geriatr Psychiatry 2020; 28:820-825. [PMID: 32245677 DOI: 10.1016/j.jagp.2020.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Alzheimer's Disease (AD)-related behavioral symptoms (i.e. agitation and/or pacing) develop in nearly 90% of AD patients. In this N = 1 study, we provide proof-of-concept of detecting changes in movement patterns that may reflect underlying behavioral symptoms using a highly novel radio sensor and identifying environmental triggers. METHODS The Emerald device is a Wi-Fi-like box without on-body sensors, which emits and processes radio-waves to infer patient movement, spatial location and activity. It was installed for 70 days in the room of patient 'E', exhibiting agitated behaviors. RESULTS Daily motion episode aggregation revealed motor activity fluctuation throughout the data collection period which was associated with potential socio-environmental triggers. We did not detect any adverse events attributable to the use of the device. CONCLUSION This N-of-1 study suggests the Emerald device is feasible to use and can potentially yield actionable data regarding behavioral symptom management. No active or potential device risks were encountered.
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Depp CA, Graham SA. Novel Sensors for Monitoring the Behavioral Symptoms of Dementia. Am J Geriatr Psychiatry 2020; 28:826-828. [PMID: 32360138 DOI: 10.1016/j.jagp.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Colin A Depp
- Department of Psychiatry, University of California (CAD, SAG), San Diego, CA; VA San Diego (CAD), San Diego CA.
| | - Sarah A Graham
- Department of Psychiatry, University of California (CAD, SAG), San Diego, CA
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Personalising Management of Behavioural and Psychological Symptoms of Dementia in Nursing Homes: Exploring the Synergy of Quantitative and Qualitative Data. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3920284. [PMID: 32695812 PMCID: PMC7368953 DOI: 10.1155/2020/3920284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022]
Abstract
Researchers have been exploring how to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in a personalised way, meanwhile, assistive technologies have been developed to collect a variety of personal data. This urges more research in investigating the combination of: data collected by the care team, which are mainly qualitative; and data collected by assistive technologies, the majority of which are quantitative. Previous studies, however, have yet to explore if and how a combination of quantitative and qualitative data could facilitate the care team to better understand each resident with dementia in the nursing home context for personalised BPSD management. Guided by a Research through Design approach, a prototype for collecting and visualising the quantitative and qualitative data towards personalised BPSD management was developed together with the care team. Via developing this prototype, knowledge was gained in what types of data could be combined for personalised BPSD management in nursing homes, what are their values, how to collect and present them, and how to introduce them in the working routine of the care team for analysis. The main findings suggest that the types of data to be collected could be unique for each resident with dementia; the quantitative and qualitative data are of value to each other during data collection and analysis; data collection should be quick and standardised yet flexible for the care team; the overview page is vital for data presentation; and user scenarios could be created to nudge the care team to analyse the data at certain points of their working routine. In general, a combination of qualitative data and quantitative data could help the care team to discover more insights about each resident with dementia and thus improve the current practice of personalised BPSD management.
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Smart Environments and Social Robots for Age-Friendly Integrated Care Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113801. [PMID: 32471108 PMCID: PMC7312538 DOI: 10.3390/ijerph17113801] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
The world is facing major societal challenges because of an aging population that is putting increasing pressure on the sustainability of care. While demand for care and social services is steadily increasing, the supply is constrained by the decreasing workforce. The development of smart, physical, social and age-friendly environments is identified by World Health Organization (WHO) as a key intervention point for enabling older adults, enabling them to remain as much possible in their residences, delay institutionalization, and ultimately, improve quality of life. In this study, we survey smart environments, machine learning and robot assistive technologies that can offer support for the independent living of older adults and provide age-friendly care services. We describe two examples of integrated care services that are using assistive technologies in innovative ways to assess and deliver of timely interventions for polypharmacy management and for social and cognitive activity support in older adults. We describe the architectural views of these services, focusing on details about technology usage, end-user interaction flows and data models that are developed or enhanced to achieve the envisioned objective of healthier, safer, more independent and socially connected older people.
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Khan SS, Spasojevic S, Nogas J, Ye B, Mihailidis A, Iaboni A, Wang A, Martin LS, Newman K. Agitation Detection in People Living with Dementia using Multimodal Sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3588-3591. [PMID: 31946653 DOI: 10.1109/embc.2019.8857781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
People Living with Dementia (PLwD) often exhibit behavioral and psychological symptoms of dementia; with agitation being one of the most prevalent symptoms. Agitated behaviour in PLwD indicates distress and confusion and increases the risk to injury to both the patients and the caregivers. In this paper, we present the use of wearable devices to detect agitation in PLwD. We hypothesize that combining multi-modal sensor data can help in building better classifiers to identify agitation in PLwD in comparison to a single sensor. We present a unique study to collect motion and physiological data from PLwD. This multi-modal sensor data is subsequently used to build predictive models to detect agitation in PLwD. The results on Random Forest for 28 days of data from PLwD show a strong evidence to support our hypothesis and highlight the importance of using multi-modal sensor data for detecting agitation events amongst them.
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Quality of Life Framework for Personalised Ageing: A Systematic Review of ICT Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082940. [PMID: 32344521 PMCID: PMC7215992 DOI: 10.3390/ijerph17082940] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Abstract
Given the growing number of older people, society as a whole should ideally provide a higher quality of life (QoL) for its ageing citizens through the concept of personalised ageing. Information and communication technologies (ICT) are subject to constant and rapid development, and can contribute to the goal of an improved QoL for older adults. In order to utilise future ICT solutions as a part of an age-friendly smart environment that helps achieve personalised ageing with an increased QoL, one must first determine whether the existing ICT solutions are satisfying the needs of older people. In order to accomplish that, this study contributes in three ways. First, it proposes a framework for the QoL of older adults, in order to provide a systematic review of the state-of-the-art literature and patents in this field. The second contribution is the finding that selected ICT solutions covered by articles and patents are intended for older adults and are validated by them. The third contribution of the study are the six recommendations that are derived from the review of the literature and the patents which would help move the agenda concerning the QoL of older people and personalised ageing with the use of ICT solutions forward.
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Behavioral Interventions for Alzheimer’s Management Using Technology: Home-Based Monitoring. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00312-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Goerss D, Hein A, Bader S, Halek M, Kernebeck S, Kutschke A, Heine C, Krueger F, Kirste T, Teipel S. Automated sensor-based detection of challenging behaviors in advanced stages of dementia in nursing homes. Alzheimers Dement 2020; 16:672-680. [PMID: 31668595 DOI: 10.1016/j.jalz.2019.08.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Sensor-based assessment of challenging behaviors in dementia may be useful to support caregivers. Here, we investigated accelerometry as tool for identification and prediction of challenging behaviors. METHODS We set up a complex data recording study in two nursing homes with 17 persons in advanced stages of dementia. Study included four-week observation of behaviors. In parallel, subjects wore sensors 24 h/7 d. Participants underwent neuropsychological assessment including MiniMental State Examination and Cohen-Mansfield Agitation Inventory. RESULTS We calculated the accelerometric motion score (AMS) from accelerometers. The AMS was associated with several types of agitated behaviors and could predict subject's Cohen-Mansfield Agitation Inventory values. Beyond the mechanistic association between AMS and behavior on the group level, the AMS provided an added value for prediction of behaviors on an individual level. DISCUSSION We confirm that accelerometry can provide relevant information about challenging behaviors. We extended previous studies by differentiating various types of agitated behaviors and applying long-term measurements in a real-world setting.
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Affiliation(s)
- Doreen Goerss
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Albert Hein
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Sebastian Bader
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sven Kernebeck
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Christina Heine
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Frank Krueger
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Thomas Kirste
- Department of Computer Science, University of Rostock, Rostock, Germany
| | - Stefan Teipel
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
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Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020; 10:1699. [PMID: 32116687 PMCID: PMC7011129 DOI: 10.3389/fphar.2019.01699] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia. Methods The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3rd of May 2019. Results A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted. Conclusions Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation. Systematic Review Registration PROSPERO, identifier CRD42019134313.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Hannah L Heintz
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Praise Owoyemi
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Aniqa T Rahman
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Cero Dinarević E, Baraković Husić J, Baraković S. Step by Step Towards Effective Human Activity Recognition: A Balance between Energy Consumption and Latency in Health and Wellbeing Applications. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5206. [PMID: 31783705 PMCID: PMC6928889 DOI: 10.3390/s19235206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 05/14/2023]
Abstract
Human activity recognition (HAR) is a classification process that is used for recognizing human motions. A comprehensive review of currently considered approaches in each stage of HAR, as well as the influence of each HAR stage on energy consumption and latency is presented in this paper. It highlights various methods for the optimization of energy consumption and latency in each stage of HAR that has been used in literature and was analyzed in order to provide direction for the implementation of HAR in health and wellbeing applications. This paper analyses if and how each stage of the HAR process affects energy consumption and latency. It shows that data collection and filtering and data segmentation and classification stand out as key stages in achieving a balance between energy consumption and latency. Since latency is only critical for real-time HAR applications, the energy consumption of sensors and devices stands out as a key challenge for HAR implementation in health and wellbeing applications. Most of the approaches in overcoming challenges related to HAR implementation take place in the data collection, filtering and classification stages, while the data segmentation stage needs further exploration. Finally, this paper recommends a balance between energy consumption and latency for HAR in health and wellbeing applications, which takes into account the context and health of the target population.
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Affiliation(s)
- Enida Cero Dinarević
- Department for Information Technology, American University in Bosnia and Herzegovina, 75000 Tuzla, Bosnia and Herzegovina
| | - Jasmina Baraković Husić
- Department of Telecommunications, Faculty of Electrical Engineering, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Sabina Baraković
- Department for IT and Telecommunication Systems, Ministry of Security of Bosnia and Herzegovina, 71000 Sarajevo, Bosnia and Herzegovina;
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Ye B, Khan SS, Chikhaoui B, Iaboni A, Martin LS, Newman K, Wang A, Mihailidis A. Challenges in Collecting Big Data in A Clinical Environment with Vulnerable Population: Lessons Learned from A Study Using A Multi-modal Sensors Platform. SCIENCE AND ENGINEERING ETHICS 2019; 25:1447-1466. [PMID: 30357559 DOI: 10.1007/s11948-018-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Agitation is one of the most common behavioural and psychological symptoms in people living with dementia (PLwD). This behaviour can cause tremendous stress and anxiety on family caregivers and healthcare providers. Direct observation of PLwD is the traditional way to measure episodes of agitation. However, this method is subjective, bias-prone and timeconsuming. Importantly, it does not predict the onset of the agitation. Therefore, there is a need to develop a continuous monitoring system that can detect and/or predict the onset of agitation. In this study, a multi-modal sensor platform with video cameras, motion and door sensors, wristbands and pressure mats were set up in a hospital-based dementia behavioural care unit to develop a predictive system to identify the onset of agitation. The research team faced several barriers in the development and initiation of the study, namely addressing concerns about the study ethics, logistics and costs of study activities, device design for PLwD and limitations of its use in the hospital. In this paper, the strategies and methodologies that were implemented to address these challenges are discussed for consideration by future researchers who will conduct similar studies in a hospital setting.
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Affiliation(s)
- Bing Ye
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada.
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
| | - Shehroz S Khan
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | - Belkacem Chikhaoui
- TELUQ University, 455 Rue du Parvis, Ville De Québec, QC, G1K 9H6, Canada
| | - Andrea Iaboni
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | | | - Kristine Newman
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Angel Wang
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Alex Mihailidis
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
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Knuff A, Leung RH, Seitz DP, Pallaveshi L, Burhan AM. Use of Actigraphy to Measure Symptoms of Agitation in Dementia. Am J Geriatr Psychiatry 2019; 27:865-869. [PMID: 30952608 DOI: 10.1016/j.jagp.2019.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and validity of actigraphy as a measurement of agitation in dementia. METHODS Participants aged 65 and older, diagnosed with dementia, residing in a geriatric psychiatry inpatient unit or long-term care facility were included in a cross-sectional study. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI). Actigraphy was measured over seven days and compared across groups categorized as low or high agitation based on a CMAI cutoff score of 50. RESULTS Twenty participants were enrolled (mean age = 74.3 years, standard deviation [SD] = 8.69). The 24-hour mean motor activity as measured with actigraphy was significantly different between the low and high agitation groups (180.23, SD = 86.34 versus 81.51, SD = 30.29, Z = 2.29; p = 0.02). Most actigraph variables had significant correlations with CMAI and NPI scores. CONCLUSION Actigraphy was highly correlated with informant-based methods for measuring agitation in individuals with dementia and actigraphy may be useful tool for measuring agitation.
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Affiliation(s)
- Amber Knuff
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Hamilton Health Sciences Centre (AK), Hamilton
| | - Roxanne H Leung
- Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston
| | - Dallas P Seitz
- Centre for Neuroscience Studies (AK, DPS), Queen's University, Kingston; Department of Psychiatry (RHL, DPS), School of Medicine, Queen's University, Kingston.
| | - Luljeta Pallaveshi
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Amer M Burhan
- Department of Psychiatry (LP, AMB), Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Band-Winterstein T, Avieli H. Women Coping With a Partner's Dementia-Related Violence: A Qualitative Study. J Nurs Scholarsh 2019; 51:368-379. [PMID: 31173457 DOI: 10.1111/jnu.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to differentiate between the lived experience of two groups of women caregiving for a partner with dementia. One group was coping with lifelong intimate partner violence (IPV) and dementia-related violence (Group 1); the other group was coping with dementia-related violence only (Group 2). DESIGN An interpretive phenomenological analysis perspective was used. Data collection was performed through in-depth, semistructured interviews with eight female spouses of men with dementia from each of the two above-mentioned groups, followed by a content analysis. FINDINGS Comparing the narratives of the aging women revealed their different experiences over several dimensions: (a) the identification of violence as a symptom of dementia; (b) the use of past couplehood memories; (c) feelings over time; (d) willingness to care for the partner with dementia; and (e) a prospective view of life. CONCLUSIONS The complexities of being old and having to cope with caregiving responsibilities for a spouse with dementia, accompanied by violent behaviors, emphasize the significance of the couple's past relationship. This notion should be taken into account in practical interventions. CLINICAL RELEVANCE As part of the aging process, there is an increase in people who are engaged in dementia-related violence. Nurses' education and practice should focus on the dynamics of dyads coping with violence and identify the particular needs of the caregiver spouse in this context.
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Affiliation(s)
- Tova Band-Winterstein
- Associate Professor, Department of Gerontology, University of Haifa, Mt. Carmel, Haifa, Israel
| | - Hila Avieli
- Lecturer, Department of Criminology, Ariel University, Ariel, Israel
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43
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Sefcik JS, Ersek M, Harnett SC, Cacchione PZ. Integrative review: Persistent vocalizations among nursing home residents with dementia. Int Psychogeriatr 2019; 31:667-683. [PMID: 30303058 PMCID: PMC6458099 DOI: 10.1017/s1041610218001205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia. METHODS We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs. RESULTS Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs. CONCLUSION The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.
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Affiliation(s)
- Justine S. Sefcik
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Mary Ersek
- Professor of Palliative Care, University of Pennsylvania School of Nursing,
418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Sasha C. Harnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Pamela Z. Cacchione
- Ralston House Term Chair in Gerontological Nursing, Associate Professor of
Geropsychiatric Nursing Clinician Educator, University of Pennsylvania School of
Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Actigraphy studies and clinical and biobehavioural correlates in schizophrenia: a systematic review. J Neural Transm (Vienna) 2019; 126:531-558. [DOI: 10.1007/s00702-019-01993-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/12/2019] [Indexed: 12/29/2022]
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Teipel S, König A, Hoey J, Kaye J, Krüger F, Robillard JM, Kirste T, Babiloni C. Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia. Alzheimers Dement 2018; 14:1216-1231. [PMID: 29936147 PMCID: PMC6179371 DOI: 10.1016/j.jalz.2018.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/20/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany.
| | - Alexandra König
- Centre Mémoire de Ressources et de Recherche (CMRR), Centre Hospitalier Universitaire Nice, Cobtek (Cognition-Behaviour-Technology) Research Lab, Université de Nice Sophia Antipolis, Nice, France
| | - Jesse Hoey
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Canada
| | - Jeff Kaye
- NIA - Layton Aging & Alzheimer's Disease Center and ORCATECH, Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA
| | - Frank Krüger
- Institute of Communications Engineering, University of Rostock, Rostock, Germany
| | - Julie M Robillard
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Thomas Kirste
- Institute of Computer Science, University of Rostock, Rostock, Germany
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "Vittorio Erspamer", University of Rome "La Sapienza", Rome, Italy; Institute for Research and Medical Care, IRCCS San Raffaele IRCCS San Raffaele and Cassino, Rome and Cassino, Italy
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