Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review

Bettina S Husebo, Hannah L Heintz, Line I Berge, Praise Owoyemi, Aniqa T Rahman, Ipsit V Vahia, Bettina S Husebo, Hannah L Heintz, Line I Berge, Praise Owoyemi, Aniqa T Rahman, Ipsit V Vahia

Abstract

Background: The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia.

Methods: The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3rd of May 2019.

Results: A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted.

Conclusions: Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation.

Systematic review registration: PROSPERO, identifier CRD42019134313.

Keywords: behavior; dementia; monitoring; sensoring; therapy.

Copyright © 2020 Husebo, Heintz, Berge, Owoyemi, Rahman and Vahia.

Figures

Figure 1
Figure 1
Flow Chart.
Figure 2
Figure 2
Framework for sustainable ethic in healthcare technology.

References

    1. Akl A., Taati B., Mihailidis A. (2015). Autonomous unobtrusive detection of mild cognitive impairment in older adults. IEEE Trans. Biomed. Eng 62 (5), 1383–1394. 10.1109/TBME.2015.2389149
    1. Aloulou H., Mokhtari M., Tiberghien T., Biswas J., Phua C., Kenneth Lin J. H., et al. (2013). Deployment of assistive living technology in a nursing home environment: methods and lessons learned. BMC Med. Info. Decis. Making 13, 42. 10.1186/1472-6947-13-42
    1. Alvarez F., Popa M., Solachidis V., Hernandez-Penaloza G., Belmonte-Hernandez A., Asteriadis S., et al. (2018). Behavior analysis through Multimodal Sensing for Care of Parkinson’s and Alzheimer’s Patients. IEEE Multimedia 25 (1), 14–25. 10.1109/MMUL.2018.011921232
    1. Asghar I., Cang S., Yu H. (2018). Impact evaluation of assistive technology support for the people with dementia. Assist. Technol. 31 (4), 180–192. 10.1080/10400435.2017.1411405
    1. Ballard C., Corbett A. (2010). Management of Neuropsychiatric Symptoms in People with Dementia. CNS Drugs 24 (9), 729–739. 10.2165/11319240-000000000-00000
    1. Ballard C., Howard R. (2006). Neuroleptic drugs in dementia: benefits and harm. Nat. Rev. Neurosci. 7 (6), 492–500. 10.1038/nrn1926
    1. Bankole A., Anderson M., Smith-Jackson T., Knight A., Oh K., Brantley J., et al. (2012). Validation of noninvasive body sensor network technology in the detection of agitation in dementia. Am. J. Alzheimers Dis. Other Demen 27 (5), 346–354. 10.1177/1533317512452036
    1. Bantry-White E. (2018). Supporting ethical use of electronic monitoring for people living with dementia: social work’s role in assessment, decision-making, and review. J. Gerontol. Soc Work 61 (3), 261–279. 10.1080/01634372.2018.1433738
    1. Brims L., Oliver K. (2018). Effectiveness of assistive technology in improving the safety of people with dementia: a systematic review and meta-analysis. Aging Ment. Health 23 (8), 942–951. 10.1080/13607863.2018.1455805
    1. Chalghoumi H., Cobigo V., Dignard C., Gauthier-Beaupré A., Jutai J. W., Lachapelle Y., et al. (2019). Information Privacy for Technology Users With Intellectual and Developmental Disabilities: Why Does It Matter? Ethics Behav. 29 (3), 201–217. 10.1080/10508422.2017.1393340
    1. Collier S., Monette P., Hobbs K., Tabasky E., Forester B. P., Vahia I. V. (2018). Mapping movement: applying motion measurement technologies to the psychiatric care of older adults. Curr. Psychiatry Rep. 20 (8), 64. 10.1007/s11920-018-0921-z
    1. Collins M. E. (2018). Occupational Therapists’ Experience with assistive technology in provision of service to clients with Alzheimer’s Disease and Related Dementias. Phys. Occup. Ther. Geriatr. 36 (2-3), 179–188. 10.1080/02703181.2018.1458770
    1. Cool A. (2019). Impossible, unknowable, accountable: dramas and dilemmas of data law. Soc Stud. Sci. 49 (4), 503–530. 10.1177/0306312719846557
    1. Crutzen R., Ygram Peters G. J., Mondschein C. (2019). Why and how we should care about the General Data Protection Regulation. Psychol. Health 34 (11), 1347–1357. 10.1080/08870446.2019.1606222
    1. de Lange D. W., Guidet B., Andersen F. H., Artigas A., Bertolini G., Moreno R., et al. (2019). Huge variation in obtaining ethical permission for a non-interventional observational study in Europe. BMC Med. Ethics 20 (1), 39–39. 10.1186/s12910-019-0373-y
    1. Dodge H. H., Zhu J., Mattek N. C., Austin D., Kornfeld J., Kaye J. A. (2015). Use of high-frequency in-home monitoring data may reduce sample sizes needed in clinical trials. PloS One 10 (9), e0138095. 10.1371/journal.pone.0138095
    1. Donnelly M., McDonagh M. (2019). Health research, consent and the GDPR exemption. Eur. J. Health Law 26 (2), 97–119. 10.1163/15718093-12262427
    1. Enshaeifar S., Zoha A., Markides A., Skillman S., Acton S. T., Elsaleh T., et al. (2018). Health management and pattern analysis of daily living activities of people with dementia using in-home sensors and machine learning techniques. PloS One 13 (5), e0195605. 10.1371/journal.pone.0195605
    1. Fleiner T., Haussermann P., Mellone S., Zijlstra W. (2016). Sensor-based assessment of mobility-related behavior in dementia: feasibility and relevance in a hospital context. Int. Psychogeriatr 28 (10), 1687–1694. 10.1017/S1041610216001034
    1. Friedman C., Rizzolo M. C. (2017). Electronic video monitoring in medicaid home and community-based services waivers for people with intellectual and developmental disabilities. J. Policy Pract. Intellect. Dis. 14 (4), 279–284. 10.1111/jppi.12222
    1. Galambos C., Skubic M., Wang S., Rantz M. (2013). Management of dementia and depression utilizing in- home passive sensor data. Gerontechnol 11 (3), 457–468. 10.4017/gt.2013.11.3.004.00
    1. Giggins O. M., Clay I., Walsh L. (2017). Physical activity monitoring in patients with neurological disorders: A review of novel body-worn devices. Digit Biomarkers 1 (1), 14–42. 10.1159/000477384
    1. Gochoo M., Tan T. H., Velusamy V., Liu S. H., Bayanduuren D., Huang S. C. (2018). Device-free non-privacy invasive classification of elderly travel patterns in a smart house using PIR Sensors and DCNN. IEEE Sensors J. 18 (1), 390–400. 10.1109/JSEN.2017.2771287
    1. Gulla C., Selbaek G., Flo E., Kjome R., Kirkevold O., Husebo B. S. (2016). Multi-psychotropic drug prescription and the association to neuropsychiatric symptoms in three Norwegian nursing home cohorts between 2004 and 2011. BMC Geriatr. 16, 115. 10.1186/s12877-016-0287-1
    1. Hattink B. J., Meiland F. J., Overmars-Marx T., de Boer M., Ebben P. W., van Blanken M., et al. (2016). The electronic, personalizable Rosetta system for dementia care: exploring the user-friendliness, usefulness and impact. Disabil. Rehabil. Assist. Technol. 11 (1), 61–71. 10.3109/17483107.2014.932022
    1. Holm S., Ploug T. (2013). Nudging and informed consent revisited: why “nudging” fails in the clinical context. Am. J. Bioeth 13 (6), 29–31. 10.1080/15265161.2013.781713
    1. Holthe T., Casagrande F. D., Halvorsrud L., Lund A. (2018). The assisted living project: a process evaluation of implementation of sensor technology in community assisted living. A feasibility study. Disabil. Rehabil. Assist. Technol. 15 (1), 29–36. 10.1080/17483107.2018.1513572
    1. Hsu Y. L., Chung P. C., Wang W. H., Pai M. C., Wang C. Y., Lin C. W., et al. (2014). Gait and balance analysis for patients with Alzheimer’s disease using an inertial-sensor-based wearable instrument. IEEE J. Biomed. Health Inform. 18 (6), 1822–1830. 10.1109/JBHI.2014.2325413
    1. Husebo B. S., Ballard C., Aarsland D., Selbaek G., Slettebo D. D., Gulla C., et al. (2019). The effect of a multicomponent intervention on quality of life in residents of nursing homes: a randomized controlled trial (COSMOS). J. Am. Med. Dir. Assoc. 20 (3), 330–339. 10.1016/j.jamda.2018.11.006
    1. Jansen C. P., Diegelmann M., Schnabel E. L., Wahl H. W., Hauer K. (2017). Life-space and movement behavior in nursing home residents: results of a new sensor-based assessment and associated factors. BMC Geriatr. 17, 36. 10.1186/s12877-017-0430-7
    1. Jekel K., Damian M., Storf H., Hausner L., Frolich L. (2016). Development of a proxy-free objective assessment tool of instrumental activities of daily living in mild cognitive impairment using smart home technologies. J. Alzheimers. Dis. 52 (2), 509–517. 10.3233/JAD-151054
    1. Kang H. G., Mahoney D. F., Hoenig H., Hirth V. A., Bonato P., Hajjar I. (2010). Innovative technology working group on advanced approaches to physiologic monitoring for the, A. (2010). In situ monitoring of health in older adults: technologies and issues. J. Am. Geriatr. Soc. 58 (8), 1579–1586. 10.1111/j.1532-5415.2010.02959.x
    1. Khan S. S., Ye B., Taati B., Mihailidis A. (2018). Detecting agitation and aggression in people with dementia using sensors-A systematic review. Alzheimers Dement 14 (6), 824–832. 10.1016/j.jalz.2018.02.004
    1. Khosla R., Nguyen K., Chu M.-T. (2017). Human robot engagement and acceptability in residential aged care. Int. J. Human–Computer Interact. 33 (6), 510–522. 10.1080/10447318.2016.1275435
    1. Kikhia B., Stavropoulos T. G., Andreadis S., Karvonen N., Kompatsiaris I., Savenstedt S., et al. (2016). Utilizing a wristband sensor to measure the stress level for people with dementia. Sensors 16 (12), 24. 10.3390/s16121989
    1. Landau R., Auslander G. K., Werner S., Shoval N., Heinik J. (2010). Families’ and professional caregivers’ views of using advanced technology to track people with dementia. Qual. Health Res. 20 (3), 409–419. 10.1177/1049732309359171
    1. Landau R., Werner S. (2012). Ethical aspects of using GPS for tracking people with dementia: recommendations for practice. Int. Psychogeriatr 24 (3), 358–366. 10.1017/S1041610211001888
    1. Lariviere M. J. (2017). Exaine current technology – enabled care practices for people with dementia in the UK: findings from accommodate. A collaborative community-based ethnography of people wliving with dementia using assistive technology and telecare at home. Alzheimer Dement 13 (7), P157. 10.1016/j.jalz.2017.06.2595
    1. Lazarou I., Karakostas A., Stavropoulos T. G., Tsompanidis T., Meditskos G., Kompatsiaris I., et al. (2016). A Novel and Intelligent Home Monitoring System for Care Support of Elders with Cognitive Impairment. J. Alzheimers Dis. 54 (4), 1561–1591. 10.3233/JAD-160348
    1. Lehoux P., Grimard D. (2018). When robots care: Public deliberations on how technology and humans may support independent living for older adults. Soc Sci.Med. 211, 330–337. 10.1016/j.socscimed.2018.06.038
    1. Lin Q., Zhang D., Chen L., Ni H., Zhou X. (2014). Managing Elders’ Wandering Behavior Using Sensors-based Solutions: A Survey. Int. J. Gerontol 8 (2), 49–55. 10.1016/j.ijge.2013.08.007
    1. Livingston G., Sommerlad A., Orgeta V., Costafreda S. G., Huntley J., Ames D., et al. (2017). Dementia prevention, intervention, and care. Lancet 390 (10113), 2673–2734. 10.1016/S0140-6736(17)31363-6
    1. Lyketsos C. G., Colenda C. C., Beck C., Blank K., Doraiswamy M. P., Kalunian D. A., et al. (2006). Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. Am. J. Geriatr. Psychiatry 14 (7), 561–572. 10.1097/01.JGP.0000221334.65330.55
    1. Mangini L., Wick J. Y. (2017). Wandering: Unearthing New Tracking Devices. Consult. Pharm. 32 (6), 324–331. 10.4140/TCP.n.2017.324
    1. Martin S., Augusto J. C., McCullagh P., Carswell W., Zheng H., Wang H., et al. (2013). Participatory research to design a novel telehealth system to support the night-time needs of people with dementia: NOCTURNAL. Int. J. Environ. Res. Public Health 10 (12), 6764–6782. 10.3390/ijerph10126764
    1. Martinez-Alcala C. I., Pliego-Pastrana P., Rosales-Lagarde A., Lopez-Noguerola J. S., Molina-Trinidad E. M. (2016). Information and Communication Technologies in the Care of the Elderly: Systematic Review of Applications Aimed at Patients With Dementia and Caregivers. JMIR Rehabil. Assist. Technol. 3 (1), e6. 10.2196/rehab.5226
    1. Mehrabian S., Extra J., Wu Y.-H., Pino M., Traykov L., Rigaud A.-S. (2014). The perceptions of cognitively impaired patients and their caregivers of a home telecare system. Med. Devices 8, 21–29. 10.2147/MDER.S70520
    1. Meiland F. J., Hattink B. J., Overmars-Marx T., de Boer M. E., Jedlitschka A., Ebben P. W., et al. (2014). Participation of end users in the design of assistive technology for people with mild to severe cognitive problems; the European Rosetta project. Int. Psychogeriatr. 26 (5), 769–779. 10.1017/S1041610214000088
    1. Melander C., Martinsson J., Gustafsson S. (2017). Measuring Electrodermal Activity to Improve the Identification of Agitation in Individuals with Dementia. Dement. Geriatr. Cogn. Dis. Extra 7 (3), 430–439. 10.1159/000484890
    1. Melander C. A., Kikhia B., Olsson M., Walivaara B. M., Savenstedt S. (2018). The Impact of Using Measurements of Electrodermal Activity in the Assessment of Problematic Behaviour in Dementia. Dement. Geriatr. Cogn. Dis. Extra 8 (3), 333–347. 10.1159/000493339
    1. Mendelson D. (2018). The European Union General Data Protection Regulation (EU 2016/679) and the Australian My Health Record Scheme - A Comparative Study of Consent to Data Processing Provisions. J. Law Med. 26 (1), 23–38. 10.2139/ssrn.3225047
    1. Merilahti J., Viramo P., Korhonen I. (2016). Wearable Monitoring of Physical Functioning and Disability Changes, Circadian Rhythms and Sleep Patterns in Nursing Home Residents. IEEE J. Biomed. Health Inform. 20 (3), 856–864. 10.1109/JBHI.2015.2420680
    1. Nijhof N., van Gemert-Pijnen L. J., Woolrych R., Sixsmith A. (2013). An evaluation of preventive sensor technology for dementia care. J. Telemed. Telecare 19 (2), 95–100. 10.1258/jtt.2012.120605
    1. Nishikata S., Yamakawa M., Shigenobu K., Suto S., Makimoto K. (2013). Degree of ambulation and factors associated with the median distance moved per day in Alzheimer’s disease patients. Int. J. Nurs. Pract. 19 Suppl 3, 56–63. 10.1111/ijn.12174
    1. Olsson A., Persson A. C., Bartfai A., Boman I. L. (2018). Sensor technology more than a support. Scand. J. Occup. Ther. 25 (2), 79–87. 10.1080/11038128.2017.1293155
    1. Pillai J. A., Bonner-Jackson A. (2015). Review of information and communication technology devices for monitoring functional and cognitive decline in Alzheimer’s disease clinical trials. J. Health Eng 6 (1), 71–83. 10.1260/2040-2295.6.1.71
    1. Ploug T., Holm S. (2013). Informed consent and routinisation. J. Med. Ethics 39 (4), 214 . 10.1136/medethics-2012-101056
    1. Robinson L., Gibson G., Kingston A. (2013). Assistive technologies in caring for the oldest old: A review of current practice and future directions. Aging Health 9 (4), 365–375. 10.2217/ahe.13.35
    1. Rostill H., Nilforooshan R., Morgan A., Barnaghi P., Ream E., Chrysanthaki T. (2018). Technology integrated health management for dementia. Br. J. Community Nurs. 23 (10), 502–508. 10.12968/bjcn.2018.23.10.502
    1. Rowe M. A., Kelly A., Horne C., Lane S., Campbell J., Lehman B., et al. (2009). Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system. Alzheimers Dement. 5 (5), 419–426. 10.1016/j.jalz.2008.08.005
    1. Sacco G., Joumier V., Darmon N., Dechamps A., Derreumaux A., Lee J. H., et al. (2012). Detection of activities of daily living impairment in Alzheimer’s disease and mild cognitive impairment using information and communication technology. Clin. Interv. Aging 7, 539–549. 10.2147/CIA.S36297
    1. Sorell T., Draper H. (2012). Telecare, surveillance, and the welfare state. Am. J. Bioeth 12 (9), 36–44. 10.1080/15265161.2012.699137
    1. Stucki R. A., Urwyler P., Rampa L., Muri R., Mosimann U. P., Nef T. (2014). A web-based non-intrusive ambient system to measure and classify activities of daily living. J. Med. Internet. Res. 16 (7), e175. 10.2196/jmir.3465
    1. Teipel S., Konig A., Hoey J., Kaye J., Kruger F., Robillard J. M., et al. (2018). Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia. Alzheimers Dement. 14 (9), 1216–1231. 10.1016/j.jalz.2018.05.003
    1. Timmers M., Van Veen E. B., Maas A. I. R., Kompanje E. J. O. (2019). Will the Eu Data Protection Regulation 2016/679 Inhibit Critical Care Research? Med. Law Rev. 27 (1), 59–78. 10.1093/medlaw/fwy023
    1. Vahia I. V., Kamat R., Vang C., Posada C., Ross L., Oreck S., et al. (2017). Use of tablet devices in the management of agitation among inpatients with dementia: an open-label study. Am. J. Geriatr. Psychiatry 25 (8) 860–864. 10.1016/j.jagp.2016.07.011
    1. van Haeften-van Dijk A. M., Meiland F. J., van Mierlo L. D., Droes R. M. (2015). Transforming nursing home-based day care for people with dementia into socially integrated community day care: process analysis of the transition of six day care centres. Int. J. Nurs. Stud. 52 (8), 1310–1322. 10.1016/j.ijnurstu.2015.04.009
    1. van Hoof J., Verboor J., Weernink C. E. O. (2018). Real-Time Location Systems for Asset Management in Nursing Homes: An Explorative Study of Ethical Aspects. Information 9 (4), 80. 10.3390/info9040080
    1. von Schomberg R. (2013). “A vision of responsible research and innovation,” in Responsible Innovation: Managing the Responsible Emergence of Science and Innovation in Society. Eds. Owen R., Bessant J., Heintz M. (London: John Wiley & Sons; ), 51–74. 10.1002/9781118551424.ch3
    1. Whelan B. M., Angus D., Wiles J., Chenery H. J., Conway E. R., Copland D. A., et al. (2018). Toward the Development of SMART Communication Technology: Automating the Analysis of Communicative Trouble and Repair in Dementia. Innov. Aging 2 (3), igy034. 10.1093/geroni/igy034
    1. Wigg J. M. (2010). Liberating the wanderers: using technology to unlock doors for those living with dementia. Sociol Health Illness 32 (2), 288–303. 10.1111/j.1467-9566.2009.01221.x
    1. Winblad B., Amouyel P., Andrieu S., Ballard C., Brayne C., Brodaty H., et al. (2016). Defeating Alzheimer’s disease and other dementias: a priority for European science and society. Lancet Neurol. 15 (5), 455–532. 10.1016/S1474-4422(16)00062-4
    1. World Health Organization (2017). 10 facts on dementia. The World Health Organization; Available from:
    1. Wortmann M. (2012). Dementia: a global health priority - highlights from an ADI and World Health Organization report. Alzheimers Res. Ther. 4 (5), 40. 10.1186/alzrt143
    1. Wu Y. T., Beiser A. S., Breteler M. M. B., Fratiglioni L., Helmer C., Hendrie H. C., et al. (2017). The changing prevalence and incidence of dementia over time - current evidence. Nat. Rev. Neurol. 13 (6), 327–339. 10.1038/nrneurol.2017.63
    1. Yamakawa M., Suto S., Shigenobu K., Kunimoto K., Makimoto K. (2012). Comparing dementia patients’ nighttime objective movement indicators with staff observations. Psychogeriatr 12 (1), 18–26. 10.1111/j.1479-8301.2011.00380.x
    1. Yang Y. T., Kels C. G. (2017). Ethical Considerations in Electronic Monitoring of the Cognitively Impaired. J. Am. Board. Fam. Med. 30 (2), 258–263. 10.3122/jabfm.2017.02.160219
    1. Yokokawa K. (2012). Usefulness of video for observing lifestyle impairments in dementia patients. Psychoger 12 (2), 137–141. 10.1111/j.1479-8301.2012.00428.x
    1. Zhou H., Sabbagh M., Wyman R., Liebsack C., Kunik M. E., Najafi B. (2017). Instrumented trail-making task to differentiate persons with no cognitive impairment, amnestic mild cognitive impairment, and alzheimer disease: a proof of concept study. Gerontol 63 (2), 189–200. 10.1159/000452309
    1. Zhou H., Lee H., Lee J., Schwenk M., Najafi B. (2018). Motor Planning Error: Toward Measuring Cognitive Frailty in Older Adults Using Wearables. Sensors 18 (3), 20. 10.3390/s18030926

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj