An app to measure functional decline in managing finances in Alzheimer’s disease: Preliminary results of the RADAR‐AD study

Abstract

Background The on‐going ‘Remote Assessment of Disease and Relapse – Alzheimer’s Disease’ (RADAR‐AD, https://www.radar-ad.org/) international study uses remote monitoring technologies (RMT’s) to continuously and objectively monitor functional decline in Alzheimer’s Disease (AD). Managing finances is an Instrumental Activity of Daily Living (IADL), usually measured via traditional pen‐paper methods and interviews. To simulate this IADL, we present the ‘Banking App’ and preliminary results from the RADAR‐AD study. Method In the app, users enter a PIN, an amount to withdraw and confirm all inputs, using a numpad on a tablet’s touchscreen that resembles an ATM (Figure 1) provided in eight translations. Metrics collected include the duration and correctness of each step (i.e. PIN, Amount and confirmation) and attempt as a whole. The 36 participants to date (Figure 2), from four European sites, performed neuropsychological tests (e.g., MMSE, Rey) and include 20 amyloid negative cognitively normal healthy controls (HC) and 16 amyloid positive, of which 6 cognitively normal preclinical AD (PreAD), 6 cognitively impaired prodromal AD (ProAD) and 4 Mild to Moderate AD (MildAD). Clinicians provided a PIN and an amount to enter from a bill in a controlled lab setting. Statistical analysis included One Way ANOVA, t‐test and Mann‐Whitney between groups in pairs and Pearson correlation. Result ANOVA showed significance between groups mainly in amount and confirmation durations (p=0.010, p=0.002), leading to t‐test in group pairs (Figures 3 in numbers, visualized in Figure 4), showing increasing durations for more cognitively impaired groups and significant difference between amount and confirmation durations between HC and MildAD (p=0.011, p=0.002). Pearson correlations and heat map (Figure 5) relate app metrics and neuropsychological tests (e.g., MMSE, ADCS with correct amount, p=0.005, and confirmation duration, p=0.001). Conclusion Preliminary findings highlight that managing finances via an app relates to cognitive assessment, further supporting the potential of this IADL in early AD using technology. This promising early data including near‐significant trends (e.g., duration of tasks between PreAD and ProAD) will be investigated deeper as the study and data collection are on‐going. This work has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking RADAR‐AD (grant No 806999) and their associated partners.

Assessing the cognitive decline of people in the spectrum of AD by monitoring their activities of daily living in an IoT-enabled smart home environment: a cross-sectional pilot study

“…Two tasks consisting of meditation sessions were also included in the protocol (Task 4 - Mindfulness Based Stress Reduction –MBSR; Crane et al, 2017 ; Creswell et al, 2019 ), and Task-5 Kirtan Kriya meditation ( Khalsa, 2015 ), where participants’ performance during meditation was monitored using a portable Muse EEG device. The protocol and the study outline have been presented in Stavropoulos et al (2021a) and Lazarou et al (2022) while the results of the meditation sessions have been reported in a separate publication ( Ioulietta et al, 2023 ). The complete protocol and the full step by step description of each Task, as given to the participants, can be found in the Supplementary information .…”

Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: Systematic Review

“…Developing metrics around the use of electronic banking has potential, although we need to be mindful that half of the adults aged between 65 and 74 years do not actually use this facility [60], which may currently be a limiting factor. Although this review was focused on continuous technology, noncontinuous technology has been used to assess this IADL, such as scripted banking tasks available on smartphones [61]. There was no standardization of metrics in all IADL domains measured [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”