1
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Teipel SJ, Temp AGM, Lutz MW. Bayesian meta-analysis of phase 3 results of aducanumab, lecanemab, donanemab, and high-dose gantenerumab in prodromal and mild Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12454. [PMID: 38389855 PMCID: PMC10883242 DOI: 10.1002/trc2.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Phase 3 trials using the anti-amyloid antibodies aducanumab, lecanemab, donanemab, and high-dose gantenerumab in prodromal and mild Alzheimer's disease dementia were heterogeneous in respect to statistical significance of effects. However, heterogeneity of results has not yet directly be quantified. METHODS We used Bayesian random effects meta-analysis to quantify evidence for or against a treatment effect, and assessed the size of the effect and its heterogeneity. Data were extracted from published studies where available and Web based data reports, assuming a Gaussian data generation process. RESULTS We found moderate evidence in favor of a treatment effect (Bayes factor = 13.2). The effect was moderate to small with -0.33 (95% credible interval -0.54 to -0.10) points on the Clinical Dementia Rating - Sum of Boxes (CDR-SB) scale. The heterogeneity parameter was low to moderate with 0.21 (0.04 to 0.45) CDR-SB points. DISCUSSION Heterogeneity across studies was moderate despite some trials reaching statistical significance, while others did not. This suggests that the negative aducanumab and gantenerumab trials are in full agreement with the expected effect sizes.
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Affiliation(s)
- Stefan J Teipel
- Working group on clincial dementia research Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock Germany
- Department of Psychosomatic Medicine University Medicine Rostock Rostock Germany
| | - Anna G M Temp
- Working group on clincial dementia research Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock Germany
- Department of Neurology Berufsgenossenschaftliches Klinikum Hamburg Hamburg Germany
| | - Michael W Lutz
- Department of Neurology Duke University School of Medicine Durham North Carolina USA
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Obayashi K, Kodate N, Ishii Y, Masuyama S. Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions. Disabil Rehabil Assist Technol 2023:1-14. [PMID: 38143315 DOI: 10.1080/17483107.2023.2287148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/19/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function. METHODS In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users. RESULTS The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs' potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders' engagement, skills and teamwork.IMPLICATIONS FOR REHABILITATIONThis proof-of-concept study tested the feasibility of a home care delivery system using sensors and remote communication device for those with dementia and disabilities.A home care delivery system was successfully created for 12 weeks by collaborative efforts among care professionals, care recipients and family caregivers in their private home environment.The introduction of in-home passive remote monitoring system increased the possibility of the older adults being able to live independently, and enabled rehabilitation at home.The users had favourable views regarding the system's preventive and interactive nature and highlighted a greater need for better integration of improved assistive technology in long-term care and rehabilitation.
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Affiliation(s)
- Kazuko Obayashi
- Faculty of Healthcare Management, Nihon Fukushi University, Mihama, Aichi, Japan
- Social Welfare Corporation Tokyo Seishin-kai, Nishitokyo, Tokyo, Japan
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
| | - Naonori Kodate
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
- Public Policy Research Center, Hokkaido University, Sapporo, Hokkaido, Japan
- Fondation France Japon, L'École des hautes études en sciences sociales, Paris, France
- Institute for Future Initiatives, University of Tokyo, Bunkyo, Tokyo, Japan
| | - Yoko Ishii
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
| | - Shigeru Masuyama
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
- Traveler's Medical Center, Tokyo Medical University, Shinjuku, Tokyo, Japan
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3
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Moshfeghi S, Jan MT, Conniff J, Ghoreishi SGA, Jang J, Furht B, Yang K, Rosselli M, Newman D, Tappen R, Smith D. In-vehicle Sensing and Data Analysis for Older Drivers with Mild Cognitive Impairment. 2023 IEEE 20TH INTERNATIONAL CONFERENCE ON SMART COMMUNITIES: IMPROVING QUALITY OF LIFE USING AI, ROBOTICS AND IOT (HONET) 2023; 2023:140-145. [PMID: 38562260 PMCID: PMC10982740 DOI: 10.1109/honet59747.2023.10374639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Driving is a complex daily activity indicating age and disease-related cognitive declines. Therefore, deficits in driving performance compared with ones without mild cognitive impairment (MCI) can reflect changes in cognitive functioning. There is increasing evidence that unobtrusive monitoring of older adults' driving performance in a daily-life setting may allow us to detect subtle early changes in cognition. The objectives of this paper include designing low-cost in-vehicle sensing hardware capable of obtaining high-precision positioning and telematics data, identifying important indicators for early changes in cognition, and detecting early-warning signs of cognitive impairment in a truly normal, day-to-day driving condition with machine learning approaches. Our statistical analysis comparing drivers with MCI to those without reveals that those with MCI exhibit smoother and safer driving patterns. This suggests that drivers with MCI are cognizant of their condition and tend to avoid erratic driving behaviors. Furthermore, our Random Forest models identified the number of night trips, number of trips, and education as the most influential factors in our data evaluation.
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Affiliation(s)
- Sonia Moshfeghi
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Muhammad Tanveer Jan
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Joshua Conniff
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | | | - Jinwoo Jang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Borko Furht
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Kwangsoo Yang
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
| | - Monica Rosselli
- Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Dana Smith
- College of Engg and Computer Science, Florida Atlantic University, Boca Raton, USA
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Timler A, Bulsara C, Bulsara M, Vickery A, Jacques A, Codde J. Examining the use of cannabidiol and delta-9-tetrahydrocannabinol-based medicine among individuals diagnosed with dementia living within residential aged care facilities: Results of a double-blind randomised crossover trial. Australas J Ageing 2023; 42:698-709. [PMID: 37321847 DOI: 10.1111/ajag.13224] [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: 02/08/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Dementia affects individuals older than 65 years. Currently, residential aged care facilities (RACF) use psychotropic medications to manage behavioural and neuropsychiatric symptoms of dementia (BPSD), which are recommended for short-term use and have substantial side effects, including increased mortality. Cannabinoid-based medicines (CBM) have some benefits that inhibit BPSD and cause minimal adverse effects (AEs), yet limited research has been considered with this population. The study aimed to determine a tolerable CBM dose (3:2 delta-9-tetrahydrocannabinol:cannabidiol), and assessed its effect on BPSD, quality of life (QoL) and perceived pain. METHODS An 18-week randomised, double-blinded, crossover trial was conducted. Four surveys, collected on seven occasions, were used to measure changes in BPSD, QoL and pain. Qualitative data helped to understand attitudes towards CBM. General linear mixed models were used in the analysis, and the qualitative data were synthesised. RESULTS Twenty-one participants (77% female participants, mean age 85) took part in the trial. No significant differences were seen between the placebo and CBM for behaviour, QOL or pain, except a decrease in agitation at the end of treatment in favour of CBM. The qualitative findings suggested improved relaxation and sleep among some individuals. Post hoc estimates on the data collected suggested that 50 cases would draw stronger conclusions on the Neuropsychiatric Inventory. CONCLUSIONS The study design was robust, rigorous and informed by RACF. The medication appeared safe, with minimal AEs experienced with CBM. Further studies incorporating larger samples when considering CBM would allow researchers to investigate the sensitivity of detecting BPSD changes within the complexity of the disease and concomitant with medications.
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Affiliation(s)
- Amanda Timler
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
| | - Alistair Vickery
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
- Emerald Clinics, Fremantle, WA, USA
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, USA
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Chen Z, Czarnuch S, Dove E, Astell A. Automated recognition of individual performers from de-identified video sequences. MACHINE LEARNING WITH APPLICATIONS 2023. [DOI: 10.1016/j.mlwa.2023.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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6
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Mc Ardle R, Jabbar KA, Del Din S, Thomas AJ, Robinson L, Kerse N, Rochester L, Callisaya M. Using digital technology to quantify habitual physical activity in community-dwellers with cognitive impairment: A systematic review (Preprint). J Med Internet Res 2022; 25:e44352. [PMID: 37200065 DOI: 10.2196/44352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Participating in habitual physical activity (HPA) can support people with dementia and mild cognitive impairment (MCI) to maintain functional independence. Digital technology can continuously measure HPA objectively, capturing nuanced measures relating to its volume, intensity, pattern, and variability. OBJECTIVE To understand HPA participation in people with cognitive impairment, this systematic review aims to (1) identify digital methods and protocols; (2) identify metrics used to assess HPA; (3) describe differences in HPA between people with dementia, MCI, and controls; and (4) make recommendations for measuring and reporting HPA in people with cognitive impairment. METHODS Key search terms were input into 6 databases: Scopus, Web of Science, Psych Articles, PsychInfo, MEDLINE, and Embase. Articles were included if they included community dwellers with dementia or MCI, reported HPA metrics derived from digital technology, were published in English, and were peer reviewed. Articles were excluded if they considered populations without dementia or MCI diagnoses, were based in aged care settings, did not concern digitally derived HPA metrics, or were only concerned with physical activity interventions. Key outcomes extracted included the methods and metrics used to assess HPA and differences in HPA outcomes across the cognitive spectrum. Data were synthesized narratively. An adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess the quality of articles. Due to significant heterogeneity, a meta-analysis was not feasible. RESULTS A total of 3394 titles were identified, with 33 articles included following the systematic review. The quality assessment suggested that studies were moderate-to-good quality. Accelerometers worn on the wrist or lower back were the most prevalent methods, while metrics relating to volume (eg, daily steps) were most common for measuring HPA. People with dementia had lower volumes, intensities, and variability with different daytime patterns of HPA than controls. Findings in people with MCI varied, but they demonstrated different patterns of HPA compared to controls. CONCLUSIONS This review highlights limitations in the current literature, including lack of standardization in methods, protocols, and metrics; limited information on validity and acceptability of methods; lack of longitudinal research; and limited associations between HPA metrics and clinically meaningful outcomes. Limitations of this review include the exclusion of functional physical activity metrics (eg, sitting/standing) and non-English articles. Recommendations from this review include suggestions for measuring and reporting HPA in people with cognitive impairment and for future research including validation of methods, development of a core set of clinically meaningful HPA outcomes, and further investigation of socioecological factors that may influence HPA participation. TRIAL REGISTRATION PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744 .
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Pigliautile M, Colombo M, Pizzuti T, Procopio N, Stillo M, Curia R, Mecocci P. DMapp: a developing promising approach to monitor symptoms progression and stimulate memory in Italian people with cognitive impairments. Aging Clin Exp Res 2022; 34:2721-2731. [PMID: 36036304 DOI: 10.1007/s40520-022-02219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Based on recent researches on the use of natural language processing techniques for very early detection of cognitive decline and the benefits of cognitive stimulation for people with cognitive impairments, the Dementia Monitoring application (DMapp) is developed inside the Memento project. AIMS The aims of this work are: (1) to present DMapp; (2) to report the results of two preliminary studies on DMapp; (3) to describe the clinical and experimental potentiality of DMapp. METHODS Italian people with the diagnosis of mild cognitive impairment due to Alzheimer's disease or dementia due to Alzheimer's Disease with a Mini-Mental-State-Examination between 24 and 28 (inclusive) were involved in the DMapp development prototype during the Lab Trial (4 subjects) and Filed Trial (5 subjects) of the Memento project. Qualitative and quantitative data were collected to evaluate participants' opinions, the DMapp ability to perform the automatic analysis of the speech and participants' visible emotional state effective. Ad hoc interviews, the Observed Emotion Rating Scale and performance metrics to solve different tasks were used. The relation between cognitive measures (global cognitive measures) and linguistic indexes values was considered using Euclidean distances between the participants. RESULTS Linguistic indexes were calculated and seemed to classify the participants' performance as expected from cognitive measures. The DMapp was appreciated by people with cognitive impairment. Positive emotions were present. CONCLUSION DMapp seems an interesting approach to monitor dementia symptoms progression and stimulate memory. Possible developments and open questions are discussed.
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Affiliation(s)
- Martina Pigliautile
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06132, Perugia, Italy.
| | - Matteo Colombo
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06132, Perugia, Italy
| | | | | | - Maria Stillo
- Innovation Lab, Integris S.P.A, Rende and Pisa, Italy
| | - Rosario Curia
- Innovation Lab, Integris S.P.A, Rende and Pisa, Italy
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli, 1, 06132, Perugia, Italy.,Division of Clinical Geriatrics NVS Department Karolinska Institutet, Stockholm, Sweden
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8
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Hackett K, Giovannetti T. Capturing Cognitive Aging in Vivo: Application of a Neuropsychological Framework for Emerging Digital Tools. JMIR Aging 2022; 5:e38130. [PMID: 36069747 PMCID: PMC9494215 DOI: 10.2196/38130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
As the global burden of dementia continues to plague our healthcare systems, efficient, objective, and sensitive tools to detect neurodegenerative disease and capture meaningful changes in everyday cognition are increasingly needed. Emerging digital tools present a promising option to address many drawbacks of current approaches, with contexts of use that include early detection, risk stratification, prognosis, and outcome measurement. However, conceptual models to guide hypotheses and interpretation of results from digital tools are lacking and are needed to sort and organize the large amount of continuous data from a variety of sensors. In this viewpoint, we propose a neuropsychological framework for use alongside a key emerging approach—digital phenotyping. The Variability in Everyday Behavior (VIBE) model is rooted in established trends from the neuropsychology, neurology, rehabilitation psychology, cognitive neuroscience, and computer science literature and links patterns of intraindividual variability, cognitive abilities, and everyday functioning across clinical stages from healthy to dementia. Based on the VIBE model, we present testable hypotheses to guide the design and interpretation of digital phenotyping studies that capture everyday cognition in vivo. We conclude with methodological considerations and future directions regarding the application of the digital phenotyping approach to improve the efficiency, accessibility, accuracy, and ecological validity of cognitive assessment in older adults.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Tania Giovannetti
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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9
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Teipel S, Gustafson D, Ossenkoppele R, Hansson O, Babiloni C, Wagner M, Riedel-Heller SG, Kilimann I, Tang Y. Alzheimer Disease: Standard of Diagnosis, Treatment, Care, and Prevention. J Nucl Med 2022; 63:981-985. [PMID: 35145015 PMCID: PMC9258577 DOI: 10.2967/jnumed.121.262239] [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: 10/01/2021] [Revised: 01/24/2022] [Indexed: 01/03/2023] Open
Abstract
Alzheimer disease (AD) is the most frequent cause of dementia in people 60 y old or older. This white paper summarizes the current standards of AD diagnosis, treatment, care, and prevention. Cerebrospinal fluid and PET measures of cerebral amyloidosis and tauopathy allow the diagnosis of AD even before dementia (prodromal stage) and provide endpoints for treatments aimed at slowing the AD course. Licensed pharmacologic symptomatic drugs enhance cholinergic pathways and moderate excess of glutamatergic transmission to stabilize cognition. Disease-modifying experimental drugs moderate or remove brain amyloidosis, but so far with modest clinical effects. Nonpharmacologic interventions and a healthy lifestyle (diet, socioaffective inclusion, cognitive stimulation, physical exercise, and others) provide some beneficial effects. Prevention targets mainly modifiable dementia risk factors such as unhealthy lifestyle, cardiovascular-metabolic and sleep-wake cycle abnormalities, and mental disorders. A major challenge for the future is telemonitoring in the real world of these modifiable risk factors.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany;,Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock/Greifswald, Rostock, Germany
| | - Deborah Gustafson
- Department of Neurology, Downstate Health Sciences University, State University of New York Brooklyn, New York, New York
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands;,Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Oskar Hansson
- Lund University, Clinical Memory Research Unit, Lund, Sweden
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “Vittorio Erspamer,” Sapienza University of Rome, Rome, Italy, and San Raffaele Cassino, Cassino, Italy
| | - Michael Wagner
- Department of Neurogenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany;,Deutsches Zentrum für Neurodegenerative Erkrankungen, Bonn, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany; and
| | - Ingo Kilimann
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany;,Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock/Greifswald, Rostock, Germany
| | - Yi Tang
- Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing, China
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10
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Lipsmeier F, Simillion C, Bamdadian A, Tortelli R, Byrne LM, Zhang YP, Wolf D, Smith AV, Czech C, Gossens C, Weydt P, Schobel SA, Rodrigues FB, Wild EJ, Lindemann M. A Remote Digital Monitoring Platform to Assess Cognitive and Motor Symptoms in Huntington Disease: Cross-sectional Validation Study. J Med Internet Res 2022; 24:e32997. [PMID: 35763342 PMCID: PMC9277525 DOI: 10.2196/32997] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/17/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Remote monitoring of Huntington disease (HD) signs and symptoms using digital technologies may enhance early clinical diagnosis and tracking of disease progression, guide treatment decisions, and monitor response to disease-modifying agents. Several recent studies in neurodegenerative diseases have demonstrated the feasibility of digital symptom monitoring. Objective The aim of this study was to evaluate a novel smartwatch- and smartphone-based digital monitoring platform to remotely monitor signs and symptoms of HD. Methods This analysis aimed to determine the feasibility and reliability of the Roche HD Digital Monitoring Platform over a 4-week period and cross-sectional validity over a 2-week interval. Key criteria assessed were feasibility, evaluated by adherence and quality control failure rates; test-retest reliability; known-groups validity; and convergent validity of sensor-based measures with existing clinical measures. Data from 3 studies were used: the predrug screening phase of an open-label extension study evaluating tominersen (NCT03342053) and 2 untreated cohorts—the HD Natural History Study (NCT03664804) and the Digital-HD study. Across these studies, controls (n=20) and individuals with premanifest (n=20) or manifest (n=179) HD completed 6 motor and 2 cognitive tests at home and in the clinic. Results Participants in the open-label extension study, the HD Natural History Study, and the Digital-HD study completed 89.95% (1164/1294), 72.01% (2025/2812), and 68.98% (1454/2108) of the active tests, respectively. All sensor-based features showed good to excellent test-retest reliability (intraclass correlation coefficient 0.89-0.98) and generally low quality control failure rates. Good overall convergent validity of sensor-derived features to Unified HD Rating Scale outcomes and good overall known-groups validity among controls, premanifest, and manifest participants were observed. Among participants with manifest HD, the digital cognitive tests demonstrated the strongest correlations with analogous in-clinic tests (Pearson correlation coefficient 0.79-0.90). Conclusions These results show the potential of the HD Digital Monitoring Platform to provide reliable, valid, continuous remote monitoring of HD symptoms, facilitating the evaluation of novel treatments and enhanced clinical monitoring and care for individuals with HD.
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Affiliation(s)
- Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Cedric Simillion
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Atieh Bamdadian
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Rosanna Tortelli
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lauren M Byrne
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yan-Ping Zhang
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Detlef Wolf
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Anne V Smith
- Ionis Pharmaceuticals Inc, Carlsbad, CA, United States
| | - Christian Czech
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland.,Rare Disease Research Unit, Pfizer, Nice, France
| | - Christian Gossens
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Patrick Weydt
- Department of Neurology, University of Ulm Medical Center, Ulm, Germany.,Department of Neurodegenerative Disease and Gerontopsychiatry/Neurology, University of Bonn Medical Center, Bonn, Germany
| | | | - Filipe B Rodrigues
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Edward J Wild
- Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Michael Lindemann
- Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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11
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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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12
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König A, Mallick E, Tröger J, Linz N, Zeghari R, Manera V, Robert P. Measuring neuropsychiatric symptoms in patients with early cognitive decline using speech analysis. Eur Psychiatry 2021; 64:e64. [PMID: 34641989 PMCID: PMC8581700 DOI: 10.1192/j.eurpsy.2021.2236] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Certain neuropsychiatric symptoms (NPS), namely apathy, depression, and anxiety demonstrated great value in predicting dementia progression, representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing. Therefore, the present study aims to investigate the association between automatically extracted speech features and NPS in patients with mild neurocognitive disorders. METHODS Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. NPS were assessed by the neuropsychiatric inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers. RESULTS Different speech variables are associated with specific NPS; apathy correlates with temporal aspects, and anxiety with voice quality-and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy, and depression scores. CONCLUSIONS Different NPS seem to be characterized by distinct speech features, which are easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS in patients with cognitive impairment. This could have great implications for the design of future clinical trials as this cost-effective method could allow more continuous and even remote monitoring of symptoms.
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Affiliation(s)
- Alexandra König
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Elisa Mallick
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Johannes Tröger
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Nicklas Linz
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Radia Zeghari
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Valeria Manera
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
| | - Philippe Robert
- Stars Team, Sophia Antipolis, Institut National de Recherche en Informatique et en Automatique (INRIA), Valbonne, France.,Clinical Research, ki:elements, Saarbrücken, Germany.,CoBTeK (Cognition-Behaviour-Technology) Lab, FRIS-University Côte d'Azur, Nice, France
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13
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Behera CK, Condell J, Dora S, Gibson DS, Leavey G. State-of-the-Art Sensors for Remote Care of People with Dementia during a Pandemic: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:4688. [PMID: 34300428 PMCID: PMC8309480 DOI: 10.3390/s21144688] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
In the last decade, there has been a significant increase in the number of people diagnosed with dementia. With diminishing public health and social care resources, there is substantial need for assistive technology-based devices that support independent living. However, existing devices may not fully meet these needs due to fears and uncertainties about their use, educational support, and finances. Further challenges have been created by COVID-19 and the need for improved safety and security. We have performed a systematic review by exploring several databases describing assistive technologies for dementia and identifying relevant publications for this review. We found there is significant need for appropriate user testing of such devices and have highlighted certifying bodies for this purpose. Given the safety measures imposed by the COVID-19 pandemic, this review identifies the benefits and challenges of existing assistive technologies for people living with dementia and their caregivers. It also provides suggestions for future research in these areas.
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Affiliation(s)
- Chandan Kumar Behera
- Intelligent Systems Research Centre, Faculty of Computing, Engineering and Built Environment, University of Ulster, Northland Road, Londonderry BT48 7JL, UK; (C.K.B.); (S.D.); (G.L.)
| | - Joan Condell
- Intelligent Systems Research Centre, Faculty of Computing, Engineering and Built Environment, University of Ulster, Northland Road, Londonderry BT48 7JL, UK; (C.K.B.); (S.D.); (G.L.)
| | - Shirin Dora
- Intelligent Systems Research Centre, Faculty of Computing, Engineering and Built Environment, University of Ulster, Northland Road, Londonderry BT48 7JL, UK; (C.K.B.); (S.D.); (G.L.)
| | - David S. Gibson
- Northern Ireland Centre for Stratified Medicine (NICSM), Biomedical Sciences Research Institute, University of Ulster, Altnagelvin Area Hospital, C-TRIC Building, Glenshane Road, Londonderry BT47 6SB, UK;
| | - Gerard Leavey
- Intelligent Systems Research Centre, Faculty of Computing, Engineering and Built Environment, University of Ulster, Northland Road, Londonderry BT48 7JL, UK; (C.K.B.); (S.D.); (G.L.)
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14
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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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15
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Camplain R, Lopez NV, Cooper DM, McKenzie TL, Zheng K, Radom-Aizik S. Development of the systematic observation of COVID-19 mitigation (SOCOM): Assessing face covering and distancing in schools. J Clin Transl Sci 2021; 5:e124. [PMID: 34258031 PMCID: PMC8267337 DOI: 10.1017/cts.2021.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, some K-12 schools resumed in-person classes with varying degrees of mitigation plans in the fall 2020. Physical distancing and face coverings can minimize SARS-CoV-2 spread, the virus that causes COVID-19. However, no research has focused on adherence to mitigation strategies during school days. Thus, we sought to develop a systematic observation protocol to capture COVID-19 mitigation strategy adherence in school environments: The Systematic Observation of COVID-19 Mitigation (SOCOM). METHODS We extended previously validated and internationally used tools to develop the SOCOM training and implementation protocols to assess physical-distancing and face-covering behaviors. SOCOM was tested in diverse indoor and outdoor settings (classrooms, lunchrooms, physical education [PE], and recess) among diverse schools (elementary, secondary, and special needs). RESULTS For the unique metrics of physical-distancing and face-covering behaviors, areas with less activity and a maximum of 10-15 students were more favorable for accurately capturing data. Overall proportion of agreement was high for physical distancing (90.9%), face covering (88.6%), activity type (89.2%), and physical activity level (87.9%). Agreement was lowest during active recess, PE, and observation areas with ≥20 students. CONCLUSIONS Millions of children throughout the USA are likely to return to school in the months ahead. SOCOM is a relatively inexpensive research tool that can be implemented by schools to determine mitigation strategy adherence and to assess protocols that allow students return to school safely and slow the spread of COVID-19.
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Affiliation(s)
- Ricky Camplain
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Nanette V. Lopez
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Dan M. Cooper
- Institute for Clinical and Translational Science, University of California Irvine, School of Medicine, Irvine, CA, USA
| | - Thomas L. McKenzie
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Kai Zheng
- Institute for Clinical and Translational Science, University of California Irvine, School of Medicine, Irvine, CA, USA
- Department of Informatics, University of California, Irvine, Irvine, CA, USA
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, University of California Irvine, School of Medicine, Irvine, CA, USA
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16
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Si Z, Wang X. Stem Cell Therapies in Alzheimer's Disease: Applications for Disease Modeling. J Pharmacol Exp Ther 2021; 377:207-217. [PMID: 33558427 DOI: 10.1124/jpet.120.000324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/03/2021] [Indexed: 12/19/2022] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease with complex pathologic and biologic characteristics. Extracellular β-amyloid deposits, such as senile plaques, and intracellular aggregation of hyperphosphorylated tau, such as neurofibrillary tangles, remain the main neuropathological criteria for the diagnosis of AD. There is currently no effective treatment of the disease, and many clinical trials have failed to prove any benefits of new therapeutics. More recently, there has been increasing interest in harnessing the potential of stem cell technologies for drug discovery, disease modeling, and cell therapies, which have been used to study an array of human conditions, including AD. The recently developed and optimized induced pluripotent stem cell (iPSC) technology is a critical platform for screening anti-AD drugs and understanding mutations that modify AD. Neural stem cell (NSC) transplantation has been investigated as a new therapeutic approach to treat neurodegenerative diseases. Mesenchymal stem cells (MSCs) also exhibit considerable potential to treat neurodegenerative diseases by secreting growth factors and exosomes, attenuating neuroinflammation. This review highlights recent progress in stem cell research and the translational applications and challenges of iPSCs, NSCs, and MSCs as treatment strategies for AD. Even though these treatments are still in relative infancy, these developing stem cell technologies hold considerable promise to combat AD and other neurodegenerative disorders. SIGNIFICANCE STATEMENT: Alzheimer's disease (AD) is a neurodegenerative disease that results in learning and memory defects. Although some drugs have been approved for AD treatment, fewer than 20% of patients with AD benefit from these drugs. Therapies based on stem cells, including induced pluripotent stem cells, neural stem cells, and mesenchymal stem cells, provide promising therapeutic strategies for AD.
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Affiliation(s)
- Zizhen Si
- Department of Physiology and Pharmacology, School of Medicine, Ningbo University, Ningbo, China (Z.S.) and Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China (X.W.)
| | - Xidi Wang
- Department of Physiology and Pharmacology, School of Medicine, Ningbo University, Ningbo, China (Z.S.) and Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China (X.W.)
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17
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Mc Ardle R, Del Din S, Donaghy P, Galna B, Thomas AJ, Rochester L. The Impact of Environment on Gait Assessment: Considerations from Real-World Gait Analysis in Dementia Subtypes. SENSORS 2021; 21:s21030813. [PMID: 33530508 PMCID: PMC7865394 DOI: 10.3390/s21030813] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/05/2023]
Abstract
Laboratory-based gait assessments are indicative of clinical outcomes (e.g., disease identification). Real-world gait may be more sensitive to clinical outcomes, as impairments may be exaggerated in complex environments. This study aims to investigate how different environments (e.g., lab, real world) impact gait. Different walking bout lengths in the real world will be considered proxy measures of context. Data collected in different dementia disease subtypes will be analysed as disease-specific gait impairments are reported between these groups. Thirty-two people with cognitive impairment due to Alzheimer’s disease (AD), 28 due to dementia with Lewy bodies (DLB) and 25 controls were recruited. Participants wore a tri-axial accelerometer for six 10 m walks in lab settings, and continuously for seven days in the real world. Fourteen gait characteristics across five domains were measured (i.e., pace, variability, rhythm, asymmetry, postural control). In the lab, the DLB group showed greater step length variability (p = 0.008) compared to AD. Both subtypes demonstrated significant gait impairments (p < 0.01) compared to controls. In the real world, only very short walking bouts (<10 s) demonstrated different gait impairments between subtypes. The context where walking occurs impacts signatures of gait impairment in dementia subtypes. To develop real-world gait assessment as a clinical tool, algorithms and metrics must accommodate for changes in context.
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Affiliation(s)
- Ríona Mc Ardle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
- Correspondence:
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
| | - Paul Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (S.D.D.); (P.D.); (B.G.); (A.J.T.); (L.R.)
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
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18
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Wayfinding in People with Alzheimer’s Disease: Perspective Taking and Architectural Cognition—A Vision Paper on Future Dementia Care Research Opportunities. SUSTAINABILITY 2021. [DOI: 10.3390/su13031084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Based on a targeted literature review, this vision paper emphasizes the importance of dementia-sensitive built space. The article specifically focuses on supporting spatial orientation and wayfinding for people living with dementia. First, we discuss types of wayfinding challenges, underlying processes, and consequences of spatial disorientation in the context of dementia of the Alzheimer’s type. Second, we focus on current efforts aimed at planning and evaluating dementia-sensitive built space, i.e., environmental design principles, interventions, evaluation tools, strategies, and planning processes. Third, we use our findings as a starting point for developing an interdisciplinary research vision aimed at encouraging further debates and research about: (1) the perspective of a person with dementia, specifically in the context of wayfinding and spatial orientation, and (2) how this perspective supplements planning and design processes of dementia-sensitive built space. We conclude that more closely considering the perspective of people with dementia supports the development of demographically sustainable future cities and care institutions.
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Tortelli R, Rodrigues FB, Wild EJ. The use of wearable/portable digital sensors in Huntington's disease: A systematic review. Parkinsonism Relat Disord 2021; 83:93-104. [PMID: 33493786 PMCID: PMC7957324 DOI: 10.1016/j.parkreldis.2021.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 01/26/2023]
Abstract
In chronic neurological conditions, wearable/portable devices have potential as innovative tools to detect subtle early disease manifestations and disease fluctuations for the purpose of clinical diagnosis, care and therapeutic development. Huntington's disease (HD) has a unique combination of motor and non-motor features which, combined with recent and anticipated therapeutic progress, gives great potential for such devices to prove useful. The present work aims to provide a comprehensive account of the use of wearable/portable devices in HD and of what they have contributed so far. We conducted a systematic review searching MEDLINE, Embase, and IEEE Xplore. Thirty references were identified. Our results revealed large variability in the types of sensors used, study design, and the measured outcomes. Digital technologies show considerable promise for therapeutic research and clinical management of HD. However, more studies with standardized devices and harmonized protocols are needed to optimize the potential applicability of wearable/portable devices in HD. Wearable/portable sensors have been proposed to detect and quantify manifestations of many neurodegenerative diseases. No systematic review so far has examined their use in Huntington's disease (HD). This work draws a broad picture of the digital wearable-based landscape in HD. The utility of wearables in clinical practice and therapeutic research still needs to be proved. Collaborative efforts are needed to further investigate their clinical use in HD.
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Affiliation(s)
- Rosanna Tortelli
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
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21
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Bellio M, Oxtoby NP, Walker Z, Henley S, Ribbens A, Blandford A, Alexander DC, Yong KXX. Analyzing large Alzheimer's disease cognitive datasets: Considerations and challenges. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12135. [PMID: 33313379 PMCID: PMC7720865 DOI: 10.1002/dad2.12135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
Recent data-sharing initiatives of clinical and preclinical Alzheimer's disease (AD) have led to a growing number of non-clinical researchers analyzing these datasets using modern data-driven computational methods. Cognitive tests are key components of such datasets, representing the principal clinical tool to establish phenotypes and monitor symptomatic progression. Despite the potential of computational analyses in complementing the clinical understanding of AD, the characteristics and multifactorial nature of cognitive tests are often unfamiliar to computational researchers and other non-specialist audiences. This perspective paper outlines core features, idiosyncrasies, and applications of cognitive test data. We report tests commonly featured in data-sharing initiatives, highlight key considerations in their selection and analysis, and provide suggestions to avoid risks of misinterpretation. Ultimately, the greater transparency of cognitive measures will maximize insights offered in AD, particularly regarding understanding the extent and basis of AD phenotypic heterogeneity.
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Affiliation(s)
- Maura Bellio
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
- UCL Interaction Centre (UCLIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Neil P. Oxtoby
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Zuzana Walker
- Division of PsychiatryUniversity College LondonLondonUK
| | - Susie Henley
- Dementia Research CentreDepartment of Neurodegeneration, National Hospital for Neurology and NeurosurgeryUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | | | - Ann Blandford
- UCL Interaction Centre (UCLIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Daniel C. Alexander
- UCL Centre for Medical Image Computing (CMIC)Department of Computer ScienceUniversity College LondonLondonUK
| | - Keir X. X. Yong
- Dementia Research CentreDepartment of Neurodegeneration, National Hospital for Neurology and NeurosurgeryUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
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22
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Si Z, Wang X. The Neuroprotective and Neurodegeneration Effects of Heme Oxygenase-1 in Alzheimer's Disease. J Alzheimers Dis 2020; 78:1259-1272. [PMID: 33016915 DOI: 10.3233/jad-200720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterized by complex pathological and biological features. Notably, extracellular amyloid-β deposits as senile plaques and intracellular aggregation of hyperphosphorylated tau as neurofibrillary tangles remain the primary premortem criterion for the diagnosis of AD. Currently, there exist no disease-modifying therapies for AD, and many clinical trials have failed to show its benefits for patients. Heme oxygenase 1 (HO-1) is a 32 kDa enzyme, which catalyzes the degradation of cellular heme to free ferrous iron, biliverdin, and carbon monoxide under stressful conditions. Several studies highlight the crucial pathological roles of HO-1 in the molecular processes of AD. The beneficial roles of HO-1 overexpression in AD brains are widely accepted due to its ability to convert pro-oxidant heme to biliverdin and bilirubin (antioxidants), which promote restoration of a suitable tissue redox microenvironment. However, the intracellular oxidative stress might be amplified by metabolites of HO-1 and exacerbate the progression of AD under certain circumstances. Several lines of evidence have demonstrated that upregulated HO-1 is linked to tauopathies, neuronal damage, and synapse aberrations in AD. Here, we review the aspects of the molecular mechanisms by which HO-1 regulates AD and the latest information on the pathobiology of AD. We further highlight the neuroprotective and neurodystrophic actions of HO-1 and the feasibility of HO-1 as a therapeutic target for AD.
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Affiliation(s)
- Zizhen Si
- Department of Physiology and Pharmacology, Ningbo University School of Medicine, Ningbo, China
| | - Xidi Wang
- Department of Biochemistry and Molecular Biology, Harbin Medical University, Harbin, China
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23
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Ault L, Goubran R, Wallace B, Lowden H, Knoefel F. Smart home technology solution for night-time wandering in persons with dementia. J Rehabil Assist Technol Eng 2020; 7:2055668320938591. [PMID: 35186320 PMCID: PMC8855416 DOI: 10.1177/2055668320938591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/28/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction More than half of persons with dementia will experience night-time wandering, increasing their risk of falls and unattended home exits. This is a major predictor of caregiver burnout and one of the major causes of early institutionalization. Methods Using smart home technologies such as sensors, smart bulbs, pressure mats and speakers, the Night-time Wandering Detection and Diversion system is designed to assist caregivers and persons with dementia that are at risk of wandering at night. Being placed in homes around Ottawa for a 12-week trial, the system allows caregivers to rest peacefully in the night, as it detects when the person with dementia gets out of bed and automatically provides cue lighting to guide them safely to the washroom. The system also uses prerecorded audio prompts, if they venture from the bedroom, only waking the caregiver when the person with dementia opens an exit door. Results Thus far, the average depression and anxiety in caregivers have been improved after the 12 weeks, and most have said that they sleep more peacefully. Conclusion The system has proven successful in supporting the safety of persons with dementia as well as their caregivers.
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Affiliation(s)
- Laura Ault
- Bruyère Research Institute, Ottawa, ON, Canada
- AGE-WELL SAM3 National Innovation Hub, Ottawa, ON, Canada
| | - Rafik Goubran
- Bruyère Research Institute, Ottawa, ON, Canada
- AGE-WELL SAM3 National Innovation Hub, Ottawa, ON, Canada
- Faculty of Engineering, Carleton University, Ottawa, ON, Canada
- Technology Assisted Friendly Environment for the Third Age, Ottawa, ON, Canada
| | - Bruce Wallace
- Bruyère Research Institute, Ottawa, ON, Canada
- AGE-WELL SAM3 National Innovation Hub, Ottawa, ON, Canada
- Faculty of Engineering, Carleton University, Ottawa, ON, Canada
- Technology Assisted Friendly Environment for the Third Age, Ottawa, ON, Canada
| | - Hailey Lowden
- Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Engineering, Carleton University, Ottawa, ON, Canada
| | - Frank Knoefel
- Bruyère Research Institute, Ottawa, ON, Canada
- AGE-WELL SAM3 National Innovation Hub, Ottawa, ON, Canada
- Faculty of Engineering, Carleton University, Ottawa, ON, Canada
- Technology Assisted Friendly Environment for the Third Age, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
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Kunik ME, Stanley MA, Shrestha S, Ramsey D, Richey S, Snow L, Freshour J, Evans T, Newmark M, Williams S, Wilson N, Amspoker AB. Aggression Prevention Training for Individuals With Dementia and Their Caregivers: A Randomized Controlled Trial. Am J Geriatr Psychiatry 2020; 28:662-672. [PMID: 32115311 PMCID: PMC7246139 DOI: 10.1016/j.jagp.2020.01.190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE International appeals call for interventions to prevent aggression and other behavioral problems in individuals with dementia (IWD). Aggression Prevention Training (APT), based on intervening in three contributors to development of aggression (IWD pain, IWD depression, and caregiver-IWD relationship problems) aims to reduce incidence of aggression in IWD over 1 year. DESIGN Randomized, controlled trial. SETTING Three clinics that assess, diagnose, and treat dementia. PARTICIPANTS Two hundred twenty-eight caregiver-IWD dyads who screened positive for IWD pain, IWD depression, or caregiver-IWD relationship problems randomized to APT or Enhanced Usual Primary Care (EU-PC). INTERVENTION APT, a skills-based intervention delivered over 3 months to address pain/depression/caregiver-IWD relationship issues. EU-PC included printed material on dementia and community resources; and eight brief, weekly support calls. MEASUREMENTS The primary outcome was incidence of aggression over 1 year, determined by the Cohen Mansfield Agitation Inventory-Aggression Subscale. Secondary outcomes included pain, depression, caregiver-IWD relationship, caregiver burden, positive caregiving, behavior problems, and anxiety. RESULTS Aggression incidence and secondary outcomes did not differ between groups. However, in those screening positive for IWD depression or caregiver-IWD relationship problems, those receiving EU-PC had significant increases in depression and significant decreases in quality of the caregiver-IWD relationship, whereas those receiving APT showed no changes in these outcomes over time. CONCLUSION The cost to patients, family, and society of behavioral problems in IWD, along with modest efficacy of most pharmacologic and nonpharmacologic interventions, calls for more study of novel preventive approaches.
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Affiliation(s)
- Mark E. Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center),Baylor College of Medicine, Houston, TX,Michael E. DeBakey VA Medical Center
| | | | - Srijana Shrestha
- Baylor College of Medicine, Houston, TX,Wheaton College, Norton, MA
| | - David Ramsey
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center),Baylor College of Medicine, Houston, TX
| | - Sheila Richey
- Baylor College of Medicine, Houston, TX,Michael E. DeBakey VA Medical Center
| | - Lynn Snow
- Tuscaloosa VA Medical Center, Tuscaloosa, AL,The University of Alabama Center for Mental Health and Aging, Tuscaloosa, AL
| | | | - Tracy Evans
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center),Baylor College of Medicine, Houston, TX
| | - Michael Newmark
- Baylor College of Medicine, Houston, TX,Kelsey Seybold Research Foundation, West University Place, TX
| | | | | | - Amber B. Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX,VA South Central Mental Illness Research, Education and Clinical Center (a virtual center),Baylor College of Medicine, Houston, TX
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25
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O'Dowd S, Schumacher J, Burn DJ, Bonanni L, Onofrj M, Thomas A, Taylor JP. Fluctuating cognition in the Lewy body dementias. Brain 2020; 142:3338-3350. [PMID: 31411317 DOI: 10.1093/brain/awz235] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023] Open
Abstract
Fluctuating cognition is a core diagnostic feature of dementia with Lewy bodies and is also a key clinical feature of Parkinson's disease dementia. These dementias share common pathological features and are referred to as Lewy body dementias. Whilst highly prevalent in Lewy body dementia, with up to 90% of patients experiencing the symptom at some point in the disease trajectory, clinical identification of fluctuating cognition is often challenging. Furthermore, its underlying pathophysiological processes remain unclear. However, neuroimaging and neurophysiological techniques have recently provided insight into potential drivers of the phenomenon. In this update, we review data pertaining to clinical features and underlying mechanisms of fluctuating cognition in Lewy body dementia. We collate evidence for different proposed aetiologies: fluctuating cognition as an attentional disorder, as a consequence of loss of cholinergic drive, as a manifestation of failure in neuronal efficiency and synchrony, and as a disorder of sleep/arousal. We also review data relating to putative mechanisms that have received less attention to date. Increased understanding of fluctuating cognition may help to illuminate pathophysiological mechanisms in cognitive processing in Lewy body dementia, guide future research, and facilitate the design of targeted therapeutic approaches.
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Affiliation(s)
- Seán O'Dowd
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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26
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Mejía-Salazar JR, Rodrigues Cruz K, Materón Vásques EM, Novais de Oliveira Jr. O. Microfluidic Point-of-Care Devices: New Trends and Future Prospects for eHealth Diagnostics. SENSORS 2020; 20:s20071951. [PMID: 32244343 PMCID: PMC7180826 DOI: 10.3390/s20071951] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
Point-of-care (PoC) diagnostics is promising for early detection of a number of diseases, including cancer, diabetes, and cardiovascular diseases, in addition to serving for monitoring health conditions. To be efficient and cost-effective, portable PoC devices are made with microfluidic technologies, with which laboratory analysis can be made with small-volume samples. Recent years have witnessed considerable progress in this area with “epidermal electronics”, including miniaturized wearable diagnosis devices. These wearable devices allow for continuous real-time transmission of biological data to the Internet for further processing and transformation into clinical knowledge. Other approaches include bluetooth and WiFi technology for data transmission from portable (non-wearable) diagnosis devices to cellphones or computers, and then to the Internet for communication with centralized healthcare structures. There are, however, considerable challenges to be faced before PoC devices become routine in the clinical practice. For instance, the implementation of this technology requires integration of detection components with other fluid regulatory elements at the microscale, where fluid-flow properties become increasingly controlled by viscous forces rather than inertial forces. Another challenge is to develop new materials for environmentally friendly, cheap, and portable microfluidic devices. In this review paper, we first revisit the progress made in the last few years and discuss trends and strategies for the fabrication of microfluidic devices. Then, we discuss the challenges in lab-on-a-chip biosensing devices, including colorimetric sensors coupled to smartphones, plasmonic sensors, and electronic tongues. The latter ones use statistical and big data analysis for proper classification. The increasing use of big data and artificial intelligence methods is then commented upon in the context of wearable and handled biosensing platforms for the Internet of things and futuristic healthcare systems.
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Affiliation(s)
- Jorge Ricardo Mejía-Salazar
- National Institute of Telecommunications (Inatel), 37540-000 Santa Rita do Sapucaí, MG, Brazil;
- Correspondence:
| | - Kamilla Rodrigues Cruz
- National Institute of Telecommunications (Inatel), 37540-000 Santa Rita do Sapucaí, MG, Brazil;
| | - Elsa María Materón Vásques
- Sao Carlos Institute of Physics, University of Sao Paulo, P.O. Box 369, 13560-970 Sao Carlos, SP, Brazil; (E.M.M.V.); (O.N.d.O.J.)
- Chemistry Department, Federal University of São Carlos, CP 676, São Carlos 13565-905, São Paulo, Brazil
| | - Osvaldo Novais de Oliveira Jr.
- Sao Carlos Institute of Physics, University of Sao Paulo, P.O. Box 369, 13560-970 Sao Carlos, SP, Brazil; (E.M.M.V.); (O.N.d.O.J.)
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27
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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: 29] [Impact Index Per Article: 7.3] [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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29
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Differentiating dementia disease subtypes with gait analysis: feasibility of wearable sensors? Gait Posture 2020; 76:372-376. [PMID: 31901765 DOI: 10.1016/j.gaitpost.2019.12.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND There are unique signatures of gait impairments in different dementia disease subtypes, such as Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease (PDD). This suggests gait analysis is a useful differential marker for dementia disease subtypes, but this has yet to be assessed using inexpensive wearable technology. RESEARCH QUESTION This study aimed to assess whether a single accelerometer-based wearable could differentiate dementia disease subtypes through gait analysis. METHODS 80 people with mild cognitive impairment or dementia due to AD, DLB or PD performed six ten-metre walks. An accelerometer-based wearable (Axivity) assessed gait. Data was processed using algorithms validated in other neurological disorders and older adults. Fourteen spatiotemporal characteristic were computed, that broadly represent pace, variability, rhythm, asymmetry and postural control features of gait. One way analysis of variance and Kruskall Wallis tests identified significant between-group differences, and post-hoc independent t-tests and Mann Whitney U's established where differences lay. Receiver Operating Characteristics and Area Under the Curve (AUC) demonstrated overall accuracy for single gait characteristics. RESULTS The wearable was able to differentiate dementia disease subtypes (p ≤ .05) and demonstrated significant differences between the groups in 7 gait characteristics with modest accuracy. For reference the instrumented walkway showed 2 between-group differences in gait characteristics. SIGNIFICANCE This study found that a wearable device can be used to differentiate dementia disease subtypes. This provides a foundation for future research to investigate the application of wearable technology as a clinical tool to aid diagnostic accuracy, allowing the correct treatment and care to be applied. Wearable technology may be particularly useful as its use is less restricted to context, making it easier to implement.
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30
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Yamada Y, Shinkawa K, Shimmei K. Atypical Repetition in Daily Conversation on Different Days for Detecting Alzheimer Disease: Evaluation of Phone-Call Data From Regular Monitoring Service. JMIR Ment Health 2020; 7:e16790. [PMID: 31934870 PMCID: PMC6996758 DOI: 10.2196/16790] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying signs of Alzheimer disease (AD) through longitudinal and passive monitoring techniques has become increasingly important. Previous studies have succeeded in quantifying language dysfunctions and identifying AD from speech data collected during neuropsychological tests. However, whether and how we can quantify language dysfunction in daily conversation remains unexplored. OBJECTIVE The objective of this study was to explore the linguistic features that can be used for differentiating AD patients from daily conversations. METHODS We analyzed daily conversational data of seniors with and without AD obtained from longitudinal follow-up in a regular monitoring service (from n=15 individuals including 2 AD patients at an average follow-up period of 16.1 months; 1032 conversational data items obtained during phone calls and approximately 221 person-hours). In addition to the standard linguistic features used in previous studies on connected speech data during neuropsychological tests, we extracted novel features related to atypical repetition of words and topics reported by previous observational and descriptive studies as one of the prominent characteristics in everyday conversations of AD patients. RESULTS When we compared the discriminative power for AD, we found that atypical repetition in two conversations on different days outperformed other linguistic features used in previous studies on speech data during neuropsychological tests. It was also a better indicator than atypical repetition in single conversations as well as that in two conversations separated by a specific number of conversations. CONCLUSIONS Our results show how linguistic features related to atypical repetition across days could be used for detecting AD from daily conversations in a passive manner by taking advantage of longitudinal data.
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Affiliation(s)
| | | | - Keita Shimmei
- IBM Research, Tokyo, Japan.,Poverty and Equity Global Practice, The World Bank, Washington, DC, United States
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31
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Predicting dementia with routine care EMR data. Artif Intell Med 2019; 102:101771. [PMID: 31980108 DOI: 10.1016/j.artmed.2019.101771] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Our aim is to develop a machine learning (ML) model that can predict dementia in a general patient population from multiple health care institutions one year and three years prior to the onset of the disease without any additional monitoring or screening. The purpose of the model is to automate the cost-effective, non-invasive, digital pre-screening of patients at risk for dementia. Towards this purpose, routine care data, which is widely available through Electronic Medical Record (EMR) systems is used as a data source. These data embody a rich knowledge and make related medical applications easy to deploy at scale in a cost-effective manner. Specifically, the model is trained by using structured and unstructured data from three EMR data sets: diagnosis, prescriptions, and medical notes. Each of these three data sets is used to construct an individual model along with a combined model which is derived by using all three data sets. Human-interpretable data processing and ML techniques are selected in order to facilitate adoption of the proposed model by health care providers from multiple institutions. The results show that the combined model is generalizable across multiple institutions and is able to predict dementia within one year of its onset with an accuracy of nearly 80% despite the fact that it was trained using routine care data. Moreover, the analysis of the models identified important predictors for dementia. Some of these predictors (e.g., age and hypertensive disorders) are already confirmed by the literature while others, especially the ones derived from the unstructured medical notes, require further clinical analysis.
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Piau A, Rumeau P, Nourhashemi F, Martin MS. Information and Communication Technologies, a Promising Way to Support Pharmacotherapy for the Behavioral and Psychological Symptoms of Dementia. Front Pharmacol 2019; 10:1122. [PMID: 31632271 PMCID: PMC6779021 DOI: 10.3389/fphar.2019.01122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/30/2019] [Indexed: 12/17/2022] Open
Abstract
Health care systems face an expansion in the number of older individuals with a high prevalence of neurodegenerative diseases and related behavioral and psychological symptoms of dementia (BPSDs). Health care providers are expected to develop innovative solutions to manage and follow up patients over time in the community. To date, we are unable to continuously and accurately monitor the nature, frequency, severity, impact, progression, and response to treatment of BPSDs after the initial assessment. Technology could address this need and provide more sensitive, less biased, and more ecologically valid measures. This could provide an opportunity to reevaluate therapeutic strategies more quickly and, in some cases, to treat earlier, when symptoms are still amenable to therapeutic solutions or even prevention. Several studies confirm the relationship between sensor-based data and cognition, mood, and behavior. Most scientific work on mental health and technologies supports digital biomarkers, not so much as diagnostic tools but rather as monitoring tools, an area where unmet needs are significant. In addition to the implications for clinical care, these real-time measurements could lead to the discovery of new early biomarkers in mental health. Many also consider digital biomarkers as a way to better understand disease processes and that they may contribute to more effective pharmaceutical research by (i) targeting the earliest stage, (ii) reducing sample size required, (iii) providing more objective measures of behaviors, (iv) allowing better monitoring of noncompliance, (v) and providing a better understanding of failures. Finally, communication technologies provide us with the opportunity to support and renew our clinical and research practices.
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Affiliation(s)
- Antoine Piau
- Gérontopôle, CHU Toulouse, Toulouse, France.,Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland, OR, United States
| | | | - Fati Nourhashemi
- Gérontopôle, CHU Toulouse, Toulouse, France.,UMR 1027, INSERM, Toulouse, France
| | - Maria Soto Martin
- Gérontopôle, CHU Toulouse, Toulouse, France.,UMR 1027, INSERM, Toulouse, France
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Mc Ardle R, Del Din S, Donaghy P, Galna B, Thomas A, Rochester L. Factors That Influence Habitual Activity in Mild Cognitive Impairment and Dementia. Gerontology 2019; 66:197-208. [DOI: 10.1159/000502288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
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Deligianni F, Guo Y, Yang GZ. From Emotions to Mood Disorders: A Survey on Gait Analysis Methodology. IEEE J Biomed Health Inform 2019; 23:2302-2316. [PMID: 31502995 DOI: 10.1109/jbhi.2019.2938111] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mood disorders affect more than 300 million people worldwide and can cause devastating consequences. Elderly people and patients with neurological conditions are particularly susceptible to depression. Gait and body movements can be affected by mood disorders, and thus they can be used as a surrogate sign, as well as an objective index for pervasive monitoring of emotion and mood disorders in daily life. Here we review evidence that demonstrates the relationship between gait, emotions and mood disorders, highlighting the potential of a multimodal approach that couples gait data with physiological signals and home-based monitoring for early detection and management of mood disorders. This could enhance self-awareness, enable the development of objective biomarkers that identify high risk subjects and promote subject-specific treatment.
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Astell AJ, Bouranis N, Hoey J, Lindauer A, Mihailidis A, Nugent C, Robillard JM. Technology and Dementia: The Future is Now. Dement Geriatr Cogn Disord 2019; 47:131-139. [PMID: 31247624 PMCID: PMC6643496 DOI: 10.1159/000497800] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Technology has multiple potential applications to dementia from diagnosis and assessment to care delivery and supporting ageing in place. OBJECTIVES To summarise key areas of technology development in dementia and identify future directions and implications. METHOD Members of the US Alzheimer's Association Technology Professional Interest Area involved in delivering the annual pre-conference summarised existing knowledge on current and future technology developments in dementia. RESULTS The main domains of technology development are as follows: (i) diagnosis, assessment and monitoring, (ii) maintenance of functioning, (iii) leisure and activity, (iv) caregiving and management. CONCLUSIONS The pace of technology development requires urgent policy, funding and practice change, away from a narrow medical approach, to a holistic model that facilitates future risk reduction and prevention strategies, enables earlier detection and supports implementation at scale for a meaningful and fulfilling life with dementia.
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Affiliation(s)
- Arlene J. Astell
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Toronto Rehabilitation Institute, Toronto, Toronto, Ontario, Canada,School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom,*Arlene J. Astell, School of Psychology & Clinical Language Sciences, University of Reading, Reading (UK), E-Mail
| | - Nicole Bouranis
- Layton Aging and Alzheimer's Disease Center, Oregon Health and Science University, Portland, Oregon, USA
| | - Jesse Hoey
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Allison Lindauer
- Oregon Roybal Center for Aging and Technology (ORCATECH), Oregon Health and Science University, Portland, Oregon, USA
| | - Alex Mihailidis
- Department of Occupational Sciences and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Chris Nugent
- School of Computing, Ulster University, Northern Ireland, United Kingdom
| | - Julie M. Robillard
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Godfrey A, Brodie M, van Schooten KS, Nouredanesh M, Stuart S, Robinson L. Inertial wearables as pragmatic tools in dementia. Maturitas 2019; 127:12-17. [PMID: 31351515 DOI: 10.1016/j.maturitas.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/02/2023]
Abstract
Dementia is a critically important issue due to its wide impact on health services as well as its personal and societal costs. Limitations exist for current dementia protocols, and there are calls to introduce modern technology that facilitates the addition of digital biomarkers to routine clinical practice. Wearable technology (wearables) are nearly ubiquitous in everyday life, gathering discrete and continuous digital data on habitual activities, but their utility in modern medicine remains low. Due to advances in data analytics, wearables are now commonly discussed as pragmatic tools to aid the diagnosis and treatment of a range of neurological disorders. Inertial sensor-based wearables are one such technology; they offer a low-cost approach to quantify routine movements that are fundamental to normal activities of daily living, most notably postural control and gait. Here, we provide a narrative review of how wearables are providing useful postural control and gait data to facilitate the capture of digital markers to aid dementia research. We outline the history of wearables, from their humble beginnings to their current use beyond the clinic, and explore their integration into modern systems, as well as the ongoing standardisation and regulatory efforts to integrate their use in clinical trials.
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Affiliation(s)
- A Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle, UK.
| | - M Brodie
- Falls Balance & Injury Research Centre, Neuroscience Research Australia, NSW, Australia; Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
| | - K S van Schooten
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, NSW, Australia
| | - M Nouredanesh
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
| | - S Stuart
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - L Robinson
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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