Selecting Remote Measurement Technologies to Optimize Assessment of Function in Early Alzheimer's Disease: A Case Study

Despite the importance of function in early Alzheimer's disease (AD), current measures are outdated and insensitive. Moreover, COVID-19 has heighted the need for remote assessment in older people, who are at higher risk of being infection and are particularly advised to use social distancing measures, yet the importance of diagnosis and treatment of dementia remains unchanged. The emergence of remote measurement technologies (RMTs) allows for more precise and objective measures of function. However, RMT selection is a critical challenge. Therefore, this case study outlines the processes through which we identified relevant functional domains, engaged with stakeholder groups to understand participants' perspectives and worked with technical experts to select relevant RMTs to examine function. After an extensive literature review to select functional domains relevant to AD biomarkers, quality of life, rate of disease progression and loss of independence, functional domains were ranked and grouped by the empirical evidence for each. For all functional domains, we amalgamated feedback from a patient advisory board. The results were prioritized into: highly relevant, relevant, neutral, and less relevant. This prioritized list of functional domains was then passed onto a group of experts in the use of RMTs in clinical and epidemiological studies to complete the selection process, which consisted of: (i) identifying relevant functional domains and RMTs; (ii) synthesizing proposals into final RMT selection, and (iii) verifying the quality of these decisions. Highly relevant functional domains were, “difficulties at work,” “spatial navigation and memory,” and “planning skills and memory required for task completion.” All functional domains were successfully allocated commercially available RMTs that make remote measurement of function feasible. This case study provides a set of prioritized functional domains sensitive to the early stages of AD and a set of RMTs capable of targeting them. RMTs have huge potential to transform the way we assess function in AD—monitoring for change and stability continuously within the home environment, rather than during infrequent clinic visits. Our decomposition of RMT and functional domain selection into identify, synthesize, and verify activities, provides a pragmatic structure with potential to be adapted for use in future RMT selection processes.

[1]  Richard Dobson,et al.  Human-Centered Design Strategies for Device Selection in mHealth Programs: Development of a Novel Framework and Case Study , 2020, JMIR mHealth and uHealth.

[2]  X. Zhang,et al.  [Psychosocial risk factors of Alzheimer's disease]. , 1999, Zhonghua yi xue za zhi.

[3]  U. S. Department of Health and Human Services FDA Cen Research,et al.  Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance , 2006, Health and quality of life outcomes.

[4]  Herbert A. Simon,et al.  The Sciences of the Artificial , 1970 .

[5]  Nils Y. Hammerla,et al.  Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study , 2017, PloS one.

[6]  M. Steinman,et al.  Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic. , 2020, JAMA internal medicine.

[7]  R. Marioni,et al.  Social activity, cognitive decline and dementia risk: a 20-year prospective cohort study , 2015, BMC Public Health.

[8]  R. Hamman,et al.  Executive Cognitive Abilities and Functional Status Among Community‐Dwelling Older Persons in the San Luis Valley Health and Aging Study , 1998, Journal of the American Geriatrics Society.

[9]  Magda Tsolaki,et al.  Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review , 2015, Alzheimer's Research & Therapy.

[10]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[11]  D. Harvey,et al.  The measurement of everyday cognition: Development and validation of a short form of the Everyday Cognition scales , 2011, Alzheimer's & Dementia.

[12]  M. Freeman,et al.  A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. , 2014, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[13]  Yaakov Stern,et al.  Scales as outcome measures for Alzheimer's disease , 2009, Alzheimer's & Dementia.

[14]  Wan-Ying Chang,et al.  How do impairments in cognitive functions affect activities of daily living functions in older adults? , 2019, PloS one.

[15]  S. Salloway,et al.  Prediction of Functional Status from Neuropsychological Tests in Community-Dwelling Elderly Individuals , 2000, The Clinical neuropsychologist.

[16]  J. Gagné Literature Review , 2018, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[17]  W. Jagust,et al.  Degree of discrepancy between self and other‐reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders , 2005, International journal of geriatric psychiatry.

[18]  C. Jack,et al.  Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment , 2004, Journal of internal medicine.

[19]  Timo Grimmer,et al.  Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome , 2006, International journal of geriatric psychiatry.

[20]  P. Scheltens,et al.  The sensitivity to change over time of the Amsterdam IADL Questionnaire© , 2015, Alzheimer's & Dementia.

[21]  J. Samet,et al.  From the Food and Drug Administration. , 2002, JAMA.

[22]  D. Zaitchik,et al.  Predicting conversion to Alzheimer disease using standardized clinical information. , 2000, Archives of neurology.

[23]  C. Jack,et al.  Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. , 2004, Archives of neurology.

[24]  Thanos G. Stavropoulos,et al.  IoT Wearable Sensors and Devices in Elderly Care: A Literature Review , 2020, Sensors.

[25]  C. Fabrigoule,et al.  Restriction in complex activities of daily living in MCI , 2006, Neurology.

[26]  M. Sano,et al.  An Inventory to Assess Activities of Daily Living for Clinical Trials in Alzheimer's Disease , 1997, Alzheimer disease and associated disorders.

[27]  D. Harvey,et al.  Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment , 2017, Journal of the American Geriatrics Society.

[28]  S. Salloway,et al.  Subcortical hyperintensities on MRI and activities of daily living in geriatric depression. , 1996, The Journal of neuropsychiatry and clinical neurosciences.

[29]  P. Aisen,et al.  Alzheimer’s Disease Clinical Trials: Moving Toward Successful Prevention , 2019, CNS Drugs.

[30]  W. Jagust,et al.  Everyday functioning in relation to cognitive functioning and neuroimaging in community-dwelling Hispanic and Non-Hispanic older adults , 2004, Journal of the International Neuropsychological Society.

[31]  Thanos G. Stavropoulos,et al.  DemaWare2: Integrating sensors, multimedia and semantic analysis for the ambient care of dementia , 2017, Pervasive Mob. Comput..