Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study

Abstract

Background Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits. Results Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants’ homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples.

The Survey for Memory, Attention, and Reaction Time (SMART): Development and Validation of a Brief Web-Based Measure of Cognition for Older Adults

“…All participants were provided written informed consent and had been previously enrolled in ongoing longitudinal studies of aging and in-home monitoring (www.orcatech.com) [21]. Participants were 69 community-dwelling older adults recruited from the Minneapolis-Saint Paul-Bloomington, Minnesota, and Portland, Oregon metropolitan areas.…”

“…The protocols were approved by the Minneapolis VA Health Care System's (MVAHCS) Institutional Review Board (IRB; #4748-A and #VAM-18-00328), the University of Minnesota's IRB (#STUDY0003177), and the Oregon Health and Science University's (OHSU) IRB (#19378). Of the 69 participants, 44 were classified as cognitively intact and 25 were classified as MCI using established clinical and research measures [21], consistent with the NIA-AA workgroup criteria. Eligibility criteria were 65 years of age or older, living independently (living with a companion or spouse was allowed, but not as a caregiver),…”

Domain Experts on Dementia-Care Technologies: Mitigating Risk in Design and Implementation

“…Investment in technology to support dementia care is growing as demand for human and financial resources to support care outpaces its supply (AARP and National Alliance for Caregiving 2020 ). The functions of technological tools range widely, including activities of daily living (ADL) assistance, behavioral and health monitoring, cognitive assistance and monitoring, and environmental and emotional support (Choi et al 2019 ; Seelye et al 2020 ; Piau et al 2019 ; Czaja et al 2019 ; Orlov 2019 ). While ethical implications of the use of technologies for people living with dementia have been slow to come into focus (Ienca et al 2018 ; Robillard et al 2018 ; Novitzky et al 2015 ), issues such as autonomy, informed consent with dementia, dignity, and distributive justice, along with threats to values like privacy and identity, are beginning to receive heightened attention in the literature (Meiland et al 2017 ; Robillard et al 2018 ; Mulvenna et al 2017 ; Sánchez et al 2017 ; Berridge 2016 ; Boise et al 2013 ).…”

The Collaborative Aging Research Using Technology Initiative: An Open, Sharable, Technology-Agnostic Platform for the Research Community

“…In addition to driving behavior, the amount of time participants spent on their computers and which applications they used was collected using WorkTime software (WorkTime, Toronto, ON, Canada) software installed on their computers [35]. Medication taking (a prospective memory task) and adherence were measured using electronic pillboxes (TimerCap, Moorpark, CA, USA); these pillboxes recorded and wirelessly transmitted back to the hub computer information about when and which pillbox doors were opened and/or closed [36]. Social engagement was measured by the amount of time participants spent outside their homes each day, which was monitored from the PIR and contact door sensors.…”