scholarly journals Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review

10.2196/12785 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e12785 ◽  
Author(s):  
Antoine Piau ◽  
Katherine Wild ◽  
Nora Mattek ◽  
Jeffrey Kaye
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Alternative Assessment ◽  
Real Life ◽  
Community Dwelling ◽  
Home Based ◽  
Passive Sensors ◽  
Digital Biomarkers

Background Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. Objective In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? Methods A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. Results An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). Conclusions Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward.

scholarly journals Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Antoine Piau ◽  
Katherine Wild ◽  
Nora Mattek ◽  
Jeffrey Kaye
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Alternative Assessment ◽  
Real Life ◽  
Community Dwelling ◽  
Home Based ◽  
Passive Sensors ◽  
Digital Biomarkers

BACKGROUND Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. OBJECTIVE In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? METHODS A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. RESULTS An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). CONCLUSIONS Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward.

Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Phoebe Ullrich ◽  
Christian Werner ◽  
Martin Bongartz ◽  
Tobias Eckert ◽  
Bastian Abel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older Persons ◽  
Controlled Trial ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Life Space ◽  
Home Based ◽  
Independent Life

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

scholarly journals Alzheimer disease biomarkers may aid in the prognosis of MCI cases initially reverted to normal

Neurology ◽  
2019 ◽  
Vol 92 (23) ◽  
pp. e2699-e2705
Author(s):  
Lisa Vermunt ◽  
Alegría J.L. van Paasen ◽  
Charlotte E. Teunissen ◽  
Philip Scheltens ◽  
Pieter Jelle Visser ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Clinical Outcome ◽  
Amyloid Pet ◽  
Clinical Markers ◽  
Disease Biomarkers ◽  
Imaging Markers ◽  
Normal Cognition

ObjectiveTo identify potential predictors for outcome in individuals with mild cognitive impairment (MCI) who have reverted to normal cognition (NC).MethodsWe selected individuals with MCI, who reverted at follow-up to NC, with follow-up after reversion from Alzheimer's Disease Neuroimaging Initiative. Common clinical markers, Alzheimer disease (AD) biomarkers, and neurodegeneration imaging markers were used to compare MCI reverters based on subsequent clinical outcome (i.e., subsequent decline or stable reversion). For independent comparison, findings of the clinical Amsterdam Dementia Cohort are presented.ResultsSeventy-seven (10%) out of 757 individuals with MCI reverted to NC and 61 of these individuals had follow-up data available. After 3.2 ± 2.2 years, 16 (24%) progressed to MCI, and 3 (5%) to dementia. Those who declined were older and had a higher amyloid PET burden and higher CSF tau levels.ConclusionIn MCI reverters, abnormal biomarkers for AD pathology are associated with subsequent decline. AD biomarkers may aid in the prognosis of reverting MCI.

scholarly journals Incidence of and Risk Factors for Missing Events Due to Wandering in Community-dwelling Older People with Dementia and Mild Cognitive Impairment

2021 ◽  
Author(s):  
seungwon Jeong ◽  
Takao Suzuki ◽  
Kiyoko Miura ◽  
Takashi Sakurai
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Recurrence Rate ◽  
Community Dwelling ◽  
Disease Assessment ◽  
People With Dementia ◽  
One Year ◽  
The One

Abstract BackgroundThe burden of missing incidents is not only on the person with dementia, but also on their family, neighbors, and community. The extent to which dementia-related wandering and missing incidents occur in the community has not been evaluated thoroughly in the published literature. Therefore, we evaluated the incidence of and risk factors for missing events due to wandering.MethodsWe conducted a non-randomized prospective one-year follow-up cohort study based on symptom registration with missing events due to wandering as the endpoint. In the first consultation, 374 patients with dementia or mild cognitive impairment (MCI) and their caregivers who visited the National Center for Geriatrics and Gerontology in Japan were included. The incidence and recurrence rate of missing events were calculated. Participants were divided into (those with) dementia and (those with) MCI. Patients' basic and medical information was documented at baseline and after one year of follow-up. Furthermore, analysis of variance and logistic regression analysis were performed to clarify the risk factors associated with the missing event.ResultsAmong the 236 patients with dementia enrolled, 65 (27·5%) had a previous missing event at baseline, and 28 had a missing event during the one-year follow-up period (recurrence rate of 43·1%). Of the 171 who did not have a previous missing event at baseline, 23 had a missing event during the one-year follow-up period (incidence rate of 13·5%). The scores of Mini-Mental State Examination (MMSE), Dementia Behavior Disturbance Scale (DBD), and Alzheimer's Disease Assessment Scale (ADAS) were statistically significant as the risk factors for the incidence of wandering leading to a missing event (p<0·05).ConclusionsPrevention of missing event due to wandering requires focused attention on changes in the MMSE, DBD, ADAS scores, and the development of a social environment to support family caregivers.

Mild Cognitive Impairment and Alzheimer Disease

2021 ◽  
pp. 662-671
Author(s):  
Philip W. Tipton ◽  
Nilüfer Ertekin-Taner
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Increased Risk ◽  
Intervention Point ◽  
Risk Of Progression

Many patients who have Alzheimer disease (AD) present initially with mild cognitive impairment (MCI). This chapter reviews the clinical features of MCI and AD, the clinical evaluation of patients with these entities, and the approaches to management. MCI is defined by cognitive decline that is more than expected by aging alone but does not meet criteria for dementia because the person has the ability to perform activities of daily living. MCI is considered to be a prodrome to dementia, especially AD, given the increased risk of progression to dementia. MCI, which probably represents the earliest stages of dementia in many patients, requires clinical follow-up and is expected to become an important intervention point in future clinical trials of novel preventive therapies.

scholarly journals Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study

2015 ◽  
Vol 44 (4) ◽  
pp. 636-641 ◽  
Author(s):  
Stella-Maria Paddick ◽  
Aloyce Kisoli ◽  
Catherine L. Dotchin ◽  
William K. Gray ◽  
Paul Chaote ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Mortality Rates ◽  
Community Dwelling ◽  
Follow Up Study

A Lack of Practice Effects on Memory Tasks Predicts Conversion to Alzheimer Disease in Patients With Amnestic Mild Cognitive Impairment

2020 ◽  
pp. 089198872094424
Author(s):  
Maria Stefania De Simone ◽  
Roberta Perri ◽  
Marta Rodini ◽  
Lucia Fadda ◽  
Massimo De Tollis ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Alzheimer Disease ◽  
Test Performance ◽  
Medial Temporal Lobe ◽  
Amnestic Mild Cognitive Impairment ◽  
Practice Effects ◽  
Large Set ◽  
Neuropsychological Evaluations

The aim of the current study was to test the accuracy of practice effects, that is, improvement in test performance due to repeated neuropsychological evaluations, in identifying patients with amnestic mild cognitive impairment (a-MCI) at greater risk of conversion to Alzheimer disease (AD). For this purpose, we conducted a longitudinal study of 54 patients diagnosed with a-MCI at the first assessment and followed-up for 4 years. During this time, 18 patients converted to AD. Baseline and 6- to 12-month follow-up performances on a large set of neuropsychological tests were analyzed to determine their diagnostic ability to predict later conversion to dementia. Results demonstrate that a lack of practice effects on episodic memory tests is an accurate prognostic indicator of late conversion to AD in a-MCI patients. In fact, even though the performance of both groups was substantially comparable at the baseline evaluation, stable a-MCI patients greatly improved their memory performance at retest after 6 to 12 months; instead, scores of converter a-MCI remained stable or decreased passing from baseline to follow-up. Standardized z-change scores on memory tasks, which were computed as a reliable measure of performance change, classified group membership with very good overall accuracy, which was higher than the classification of converter and stable a-MCIs provided by baseline or follow-up scores. We hypothesize that the lack of practice effects on memory tasks mirrors the early involvement of medial temporal lobe areas in converter a-MCI that are fundamental for the consolidation of new memory traces.

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