Prinicpal Investigator: SkubicCo-Investigators: Lane, Popescu, Rantz, Robinson, Shenker
Sensing technologies hold enormous potential for detecting and tracking health changes that can dramatically affect the aging experience. Embedded health assessment can improve management of chronic or acute conditions, and thus, improve quality of life. Problems in chronic disease management are often the cause of losing independence for aging Americans. Chronic disease management is further complicated when patients have Alzheimer’s Disease or Related Dementias (ADRD). In 2018, approximately 5.5 million people over the age of 65 years (10%) have been diagnosed with ADRD. These numbers rise with age; 32% of people over 85 years have been diagnosed. Sensing technologies address this challenge by monitoring for health changes so that early interventions can be offered (even when the patient may not be able to tell us there is a problem) when treatment is most effective, prevention of decline is still possible, and costs can be controlled. Early illness recognition and early treatment improves health status with rapid recovery after an exacerbation of a chronic illness or acute illness and also reduces morbidity and mortality in older adults with ADRD.
In previous work, we developed a health alert system that captures and analyzes data from sensors embedded in the home. Sensor data are captured passively and continuously; clinical staff receive health change alerts, which are generated automatically from the system, thereby allowing early treatment. In the current parent grant, we are extending this work by incorporating more finely grained in-home sensing, exploring the use of wearable health and fitness trackers, and studying new algorithms that integrate changes in health status and medication use for customized alerts that recognize health change very early. We are also redesigning our existing clinician-focused interface for displaying sensor data to empower older adults and family members to better self-manage chronic health conditions while addressing their privacy concerns.
The purpose of the proposed supplement is to extend the sensor system and consumer-focused interface for monitoring patients with ADRD and explore new methods for early detection and tracking progression of ADRD. The long-term goal is to use the in-home sensor system to track changes in cognition for future studies. We propose an exploratory study monitoring ADRD patients living in the community with family to investigate possible correlations between features extracted from in-home sensor data streams and cognitive health trajectories. Correlations identified using in-home sensor data could then support larger scale studies that investigate a variety of interventions designed for ADRD patients, such as medications, activities to promote functionality, or therapeutic interventions such as cognitive stimulation therapy. Using the in-home sensor system to track cognition has the potential to provide more finely grained data on cognitive status, as the information will be based on continuous readings in the home daily rather than less frequent, episodic assessments in the clinic.
In the supplement pilot study, target participants will be living in the community with family, and will have a clinical dementia rating score of 0.5 (very mild dementia, also known as mild cognitive impairment) or (mild dementia). New parameters will be estimated from the in-home sensors, especially on sleep efficiency, sleep latency, and sleep stages to test correlations with cognitive changes. We will also test additional gait parameters estimated from the in-home depth sensor system, e.g., entropy and symmetry. These have been validated previously in the lab but not yet tested in the home. Previous studies by our team as well as others offer a strong potential for identifying new parameters on sleep, gait, and activity that can be used to track cognitive trajectories noninvasively in the home. These offer new methods in treating and studying patients with ADRD as well as tracking the progression of the disease and treatment effectiveness.
The proposed supplement study also leverages our current parent grant in the investigation of a new consumer-focused interface for seniors living in independent senior housing and their designated family members. In the parent grant, we have conducted focus groups with seniors and family. Based on the results, we developed two prototype voice assistant systems that are currently being tested. From the focus groups, we also know that seniors and family members want smartphone access. The proposed supplement will use these results as a starting point for the ADRD patients and family members. Investigation with this new population will study their perceptions and opinions of the sensor system and the consumer interface.
New Specific Aims for Supplement
- Using in-home sensors, capture sleep patterns (sleep time and quality, restlessness, sleep stages), walking gait, and general activity of ADRD patients during their normal daily activities in the home; extend the consumer interface to display these data trends.
- Capture the user feedback of the monitored ADRD patients with neurocognitive disorder and their family members about the sensor system and consumer interface.
- Explore changes in sensor data trends that could be used for guiding medication decisions, choosing activities that promote functionality, or tracking the effectiveness of interventions such as cognitive stimulation therapy.