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Technology to Advance Assessment & Interventions for Dementia
Jeffrey Kaye
Layton Professor of Neurology & Biomedical Engineering
ORCATECH - Oregon Center for Aging & Technology
NIA - Layton Aging & Alzheimer's Disease Center http://www.orcatech.org; http://www.carthome.org
Contemporary Assessment
"How long have you been here? She seems to be trying to remember. Three weeks. What is this? I show her a pencil. A pen. A purse, key, diary and cigar are identified correctly. ... When objects are shown to her, she does not remember after a short time which objects have been shown..."
--- A. Alzheimer, Nov. 6, 1901
Still crazy after all these years...
Detecting Meaningful Change
High variability in cognitive tests
-- ADNI Memory Composite Dodge et. al., 2014
High variability in self-report measures
-- UCLA Loneliness Scale
Austin et al., 2016
The way it should be...
Pervasive Computing Technologies
Transform the ability to detect meaningful change
Increase the speed or efficiency of clinical trials and dementia research in general
Provide new fundamental insights into human biology and behavior
Transform the ability to detect meaningful change
Challenges to developing new therapies
Increase the speed or efficiency of clinical trials and dementia research in general
MCI Prevention Trial -- Sample Size Estimates
Current Method
Continuous Measures
LM Delayed Recall*
Computer Use**
Walking Speed**
SAMPLE SIZE TO SHOW 50% EFFECT
688
10
94
SAMPLE SIZE TO SHOW 30% EFFECT
1912
26
262
SAMPLE SIZE TO SHOW 20% EFFECT
4300
58
588
Dodge, et al., PLoS One, 2015
Reduces required sample size and/or time to identify meaningful change.
Reduces exposure to harm (fewer needed/ fewer exposed)
More precise estimates of the trajectory of change; allows for intra-individual predictions.
Provides the opportunity to substantially improve efficiency and inform go/no-go decisions of trials.
Provide new insights into human biology and behavior
Disrupted Infradian Rhythms in MCI
Reynolds, et al., 2017
How? NIA - Technology Agnostic R & D Platform ORCATECH Life Laboratory + CART
Kaye et al. J of Gerontol, 2011; Lyons et al. Frontiers in Aging Neurosci, 2015; Kaye et al. J of Visualized Experiments, 2018
Established to address needed research capability for evidence building (facilitated by technology) in aging research.
Goal: Design and implement a scalable, disseminated technology system ('platform') for more effective aging research, ultimately deployable to 10,000+ homes
Focus on diversity, technology agnosticism, "future-proofing", use case flexibility, sustainability, facilitating secure data sharing.
Interagency U2C (U2CAG054397) with NIH (NIA, NIBIB, NCI, NINDS, NINR, NCATS, OBSSR,) and VA
Research Team: PI, Jeffrey Kaye, ORCATECH/Oregon Health & Science University; Nina Silverberg, NIA; Collaborators: Intel, U. Miami, Cornell, Rush, OSU, U. Penn, VA VISN 20
CART + ORCATECH Sites/Homes in U.S. and Canada
Assessments - Examples
Developing PD and Tx Response
Physical Activity and Mobility Behaviors
Room activity distributions differentiating MCI vs not MCI
Digital functional activity composite relative to plaque score
Digital Composite = Mobility + Cognition + Sleep + Socialization
Technologies advancing dementia intervention research - Examples
Ambient Independence Measures (AIMS) for Guiding Care Transitions (R01AG042191)
During the three years of study -- low staff engagement:
11/26 consented staff members logged in at least once to the activity dashboard.
Staff "page views", that is, number of pages of data looked at, ranged from 4-211 over the duration of data collection.
Mean seconds spent on a particular page view was 36 (range, 1-750)
Across 5 monthly email surveys, response rate of 31% (23/73).
Ambient Independence Measures Guiding Care Transitions
Bottom Line:
Technology worked well with unique metrics acting both as assessment and intervention
Inconclusive results -- despite high engagement and enthusiasm at entry and booster sessions, inadequate engagement of staff across 7 communities
Care system designed for crisis intervention
Realizing proactive action on trend data is an unmet need
Objective in-home monitoring to identify meaningful behaviours changing during a loneliness intervention
Intervention: "Capturing Time: Journaling Your Journey" -- designed to improve negative emotions such as loneliness, depression, anxiety, and low self-esteem.
Austin et al. IEEE Journal of Translational Engineering in Health Medicine 2016
Capturing Time: digital biomarker results
Austin, et al. 2018
Loneliness (p<0.05) by an average of 2.2 ± 3 points.
Time out-of-home (ß=0.96, p<0.01)
Number of computer sessions (IRR=1.196, p<0.01)
Walking speed over time (ß = 0.002, p<0.01).
Total phone calls, after intervention (IRR=1.003, p<0.01)
Multi-modal Brain Health Program - SHARP: Sharing History through Active Reminiscence and Photo-imagery
PI: Raina Croff; NIA: P30AG008017, P30AG024978, and Alzheimer's Association
Croff R, et al. The Gerontologist, 2018.
The "Social Engagement Study" (H. Dodge, PI)
Active, Frequent Assessments & Interventions Delivered Everyday - an RCT to Increase Social Interaction in MCI Using Home-based Technologies
6 week RCT of daily 30 min video chats using Internet connected personal computers with a webcam vs. weekly brief phone interview
N = 86; 80.5 ± 6.8 years; MCI & Normal Cognition
89% of all possible sessions completed; Exceptional adherence -- no drop-out
Dodge et al. Alzheimer's & Dementia: Translational Res. & Clinical Interventions, 2015
Dodge et al., Current Alzheimer's Disease, 2015
Computer Use: Social Markers of Cognitive Function
Table 4. Average number of words grouped into LIWC categories
LIWC cat.
Communication
Swear
Anger
Fillers
Family
Avg. num. in MCI
46.4
7.14
37
101.5
31.14
Avg. num. in intact
38.7
4.8
49.8
141.6
41.8
p-value
0.002
0.005
0.054
0.067
0.08
MCI participants generate a greater proportion of words (2985 vs. 2423 words on average) out of the total number of words during the conversation sessions (p=0.03).
Logistic regression models showed the ROC AUC of identifying MCI (vs. normals) was 0.71 (95% Confidence Interval: 0.54 - 0.89) when average proportion of word counts spoken by subjects was included in the model.
Dodge et al. Current Alzheimer Res. 2015 Asgari et al. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2017
Reynolds et al., 2017 unpublished
Thomas et al., AAIC 2017
Digital Biomarkers in Later Stage Dementia Interventions
ADCS PEACE-AD RCT: Prazocin for Agitation in AD RCT (Pis: Peskind & Raskin; Lim, Reynolds, Kaye)
Digital Agitation Assessment - Activity levels monitored continuously during entire 12-wk titration study using wrist actigraphy. Continuous monitoring critical as study employs a flexible dose titration schedule, and the use of rescue medication.
MODERATE - Monitoring Dementia-related Agitation using Technology-assisted Evaluations -
Multiple sensors used to examine the effects of environment on dementia-associated behaviors.
Loneliness (p<0.05) by an average of 2.2 ± 3 points.
Time out-of-home (ß=0.96, p<0.01)
