Monitoring Behaviors of Patients With Late-Stage Dementia Using Passive Environmental Sensing Approaches: A Case Series

Abstract

Objective: To show the feasibility of using different unobtrusive activity-sensing technologies to provide objective behavioral markers of persons with dementia (PwD).

Design: Monitored the behaviors of two PwD living in memory care unit using the Oregon Center for Aging & Technology (ORCATECH) platform, and the behaviors of two PwD living in assisted living facility using the Emerald device.

Setting: A memory care unit in Portland, Oregon and an assisted living facility in Framingham, Massachusetts.

Participants: A 63-year-old male with Alzheimer's disease (AD), and an 80-year-old female with frontotemporal dementia, both lived in a memory care unit in Portland, Oregon. An 89-year-old woman with a diagnosis of AD, and an 85-year-old woman with a diagnosis of major neurocognitive disorder, Alzheimer's type with behavioral symptoms, both resided at an assisted living facility in Framingham, Massachusetts.

Measurements: These include: sleep quality measured by the bed pressure mat; number of transitions between spaces and dwell times in different spaces measured by the motion sensors; activity levels measured by the wearable actigraphy device; and couch usage and limb movements measured by the Emerald device.

Results: Number of transitions between spaces can identify the patient's episodes of agitation; activity levels correlate well with the patient's excessive level of agitation and lack of movement when the patient received potentially inappropriate medication and neared the end of life; couch usage can detect the patient's increased level of apathy; and periodic limb movements can help detect risperidone-induced side effects. This is the first demonstration that the ORCATECH platform and the Emerald device can measure such activities.

Conclusion: The use of technologies for monitoring behaviors of PwD can provide more objective and intensive measurements of PwD behaviors.

Keywords: Alzheimer's disease; Unobtrusive activity-sensing technology; agitation; apathy; behavioral and psychological symptoms; end-of-life; late-stage dementia; potentially inappropriate medication; technology.

Conflict of interest statement

Disclosure/Conflicts of Interest

Dr. Au-Yeung reports grants from National Institute on Aging, during the conduct of the study. Dr. Beattie reports grants from National Institutes of Health, during the conduct of the study. Dr. Kabelac reports personal fees from Emerald Innovations Inc, outside the submitted work. Dr. Katabi reports other from Emerald innovations, outside the submitted work; In addition, Dr. Katabi has a patent Motion tracking via body radio reflections issued to Emerald innovations. Dr. Kaye reports grants from National Institute on Aging, during the conduct of the study. Dr. Vahia reports other from American Journal of geriatric psychiatry, outside the submitted work. For the remaining authors none were declared.

Copyright © 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:

A: Boxplot of the number of transitions between subsections within the main living space on nights with PRN medication treated agitation versus nights without PRN medication treated agitation. B: Boxplot of the sleep score from Emfit on nights with PRN medication treated agitation versus nights without PRN medication treated agitation.

Figure 2:

Participant’s locations in the main living space during the 15 nights with PRN medication treated agitation (A) vs participant’s locations in the main living space during 15 randomly selected nights without PRN medication treated agitation (B). Time periods highlighted red indicates that presence detected around the bed, blue indicates presence detected around the futon, green indicates presence detected around the front door, yellow indicates presence detected around the bathroom. The black diamonds indicate the times PRN medications were administered to the patient.

Figure 3:

Line chart of daily total activity counts from the wearable actigraphy device worn by the patient in case 2. Red vertical lines indicate days with occurrences of agitation. Notable events are annotated with green text.

Figure 4:

A: Daily couch usage over 0 to 57 days after baseline. On Day 8, trazodone reduced from 50 to 25mg. On Day 22, dronabinol 2.5mg discontinued. On Day 36, mirtazapine increased from 7.5 to 15mg. On Day 50, mirtazapine discontinued and bupropion introduced. B: Couch usage over two months by time of day.

Figure 5:

A: Limb and vital signs motion captured from the bed area over time. B: Filtered motion signal to extract Periodic Limb Movements.