Measuring Electrodermal Activity to Improve the Identification of Agitation in Individuals with Dementia

Catharina Melander, Jesper Martinsson, Silje Gustafsson, Catharina Melander, Jesper Martinsson, Silje Gustafsson

Abstract

Background: Understanding and interpreting the complexity of agitation in people with dementia is challenging.

Objective: To explore whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia.

Methods: Nine individuals with dementia wore a sensor that measured EDA. During the same time, assistant nurses annotated the observed behavior of the person with dementia. A binary logistic regression model was applied to assess the relationship between the sensor and the assistant nurses' structured observations of agitation.

Results: The sensor values correlated with the assistant nurses' observations both at the time of the observation and 1 and 2 h prior to the observation.

Conclusion: A sensor measuring EDA can support early detection of agitation in persons with dementia.

Keywords: Agitation; Behavioral psychological symptoms in dementia; Dementia; Electrodermal activity.

Figures

Fig. 1.
Fig. 1.
Example of an observation scheme filled in by assistant nurses. Assistant nurses were provided with an observation scheme where specific predetermined colors were used for each behavior. Behaviors commonly occurring in advanced dementia were presented in the observational 24-h timeline scheme including worriedness, aggression, and sleep. It was also possible to add information to the scheme if needed.
Fig. 2.
Fig. 2.
An example of the structured observations made by assistant nurses combined with the sensor values. Observations made by assistant nurses indicates awake/calm (0) and agitation (1). An increasing sensor value (0–5) indicates an increase in electrodermal activity at the time of the observation.
Fig. 3.
Fig. 3.
Correlations between sensor values and assistant nurses' observations of agitation at the time of the observation (0 h) as well as 1 and 2 h prior to the observation. There was a significant correlation (p < 0.01) between assistant nurses' observations of agitation and sensor values both at the time of the observation (0.473) and 1 h (0.47) and 2 h (0.455) prior to the observation.

References

    1. Cohen-Mansfield J, Dakheel-Ali M, Marx MS, Thein K, Regier NG. Which unmet needs contribute to behavior problems in persons with advanced dementia? Psychiatry Res. 2015;228:59–64.
    1. Kocielnik R, Sidorova N, Maggi FM, Ouwerkerk M, Westerink JHDM. Smart technologies for long-term stress monitoring at work. Proc IEEE Int Symp Comput Based Med Syst. 2013;2013:53–58.
    1. Kolb B, Whishaw IQ. An Introduction to Brain and Behaviour. ed 2. New York: Worth; 2006.
    1. Sharma M, Kacker S, Sharma M. A brief introduction and review on galvanic skin response. Int J Med Res Prof. 2016;2:13–17.
    1. Kong EH. Agitation in dementia: concept clarification. J Adv Nurs. 2005;52:526–536.
    1. Ornstein K, Gaugler JE. The problem with “problem behaviors”: a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. Int Psychogeriatr. 2012;24:1536–1552.
    1. Kessler RC, Cohen S, Gordon LU. New York: Oxford University Press; 1997. Measuring Stress: A Guide for Health and Social Scientists (electronic resource)
    1. Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. I. A conceptual review. J Am Geriatr Soc. 1986;34:711–721.
    1. Selbæk G, Engedal K, Benth J, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. 2014;26:81–91.
    1. Wetzels R, Zuidema S, Jansen I, Verhey F, Koopmans R. Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: a systematic review. Int Psychogeriatr. 2010;22:1040–1053.
    1. Hongisto K, Hallikainen I, Selander T, Törmälehto S, Väätäinen S, Martikainen J, Välimäki T, Hartikainen S, Suhonen J, Koivisto AM. Quality of life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5-year prospective ALSOVA cohort study. Int J Geriatr Psychiatry. 2017 Epub ahead of print.
    1. Wetzels RB, Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Prescribing pattern of psychotropic drugs in nursing home residents with dementia. Int Psychogeriatr. 2011;23:1249–1259.
    1. Wijsman J, Grundlehner B, Liu H, Hermens H, Penders J. Towards mental stress detection using wearable physiological sensors. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:1798–1801.
    1. Kuijpers E, Nijman H, Bongers IMB, Lubberding M, Ouwerkerk M. Can mobile skin conductance assessments be helpful in signalling imminent inpatient aggression? Acta Neuropsychiatr. 2012;24:56–59.
    1. Kuijsters A, Redi J, de Ruyter B, Heynderickx I. Lighting to make you feel better: improving the mood of elderly people with affective ambiences. PLoS One. 2015;10:e0132732.
    1. Fong SS, Navarrete CD, Perfecto SE, Carr AR, Jimenez EE, Mendez MF. Behavioral and autonomic reactivity to moral dilemmas in frontotemporal dementia versus Alzheimer's disease. Soc Neurosci. 2017;12:409–418.
    1. Zuidema SU, de Jonghe JF, Verhey FR, Koopmans RT. Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians' prescription behavior. Int Psychogeriatr. 2011;23:1632–1639.
    1. Zwijsen SA, Kabboord A, Eefsting JA, Hertogh CMPM, Pot AM, Gerritsen DL, Smalbrugge M. Nurses in distress? An explorative study into the relation between distress and individual neuropsychiatric symptoms of people with dementia in nursing homes. Int J Geriatr Psychiatry. 2014;29:384–391.
    1. Gitlin LN, Marx KA, Stanley IH, Hansen BR, van Haitsma KS. Assessing neuropsychiatric symptoms in people with dementia: a systematic review of measures. Int Psychogeriatr. 2014;26:1805–1848.
    1. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–2314.
    1. Cummings JL, McPherson S. Neuropsychiatric assessment of Alzheimer's disease and related dementias. Aging (Milano) 2001;13:240–246.
    1. Remmers H. Environments for ageing, assistive technology and self-determination: ethical perspectives. Inform Health Soc Care. 2010;35:200–210.
    1. Dewing J. Participatory research: a method for process consent with persons who have dementia. Dementia. 2007;6:11–25.
    1. Polit DF, Beck CT. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012. Nursing Research: Generating and Assessing Evidence for Nursing Practice.
    1. Kikhia B, Stavropoulos TG, Andreades S, Karvonen N, Kompatsiaris I, Sävenstedt S, Pijl M, Melander C. Utilizing a wristband sensor to measure the stress level for people with dementia. Sensors (Basel) 2016;16:E1989.
    1. Wilhelm FH, Grossman P. Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment. Biol Psychol. 2010;84:552–569.
    1. Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. Int J Geriatr Psychiatry. 2009;24:1079–1086.
    1. Dawson B, Trapp RG. ed 4. New York: Lange Medical Books/McGraw-Hill; 2004. Basic and Clinical Biostatistics.
    1. Gelman A, Hill J. Cambridge: Cambridge University Press; 2007. Data Analysis Using Regression and Multilevel/Hierarchical Models.
    1. Visnovcova Z, Mestanik M, Gala M, Mestanikova A, Tonhajzerova I. The complexity of electrodermal activity is altered in mental cognitive stressors. Comput Biol Med. 2016;79:123–129.
    1. Kreibig SD. Autonomic nervous system activity in emotion: a review. Biol Psychol. 2010;84:394–421.
    1. Khalfa S, Peretz I, Blondin JP, Manon R. Event-related skin conductance responses to musical emotions in humans. Neurosci Lett. 2002;328:145–149.
    1. McCormack B, McCance TV. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56:472–479.
    1. McCormack B. A conceptual framework for person-centred practice with older people. Int J Nurs Pract. 2003;9:202–209.
    1. Gandhi DK, Singh J. Ageing and autonomic nervous system activity. J Phys Pharm Adv. 2012;2:307–311.
    1. Gavazzeni J, Fischer H, Wiens S. Age effects to negative arousal differ for self-report and electrodermal activity. Psychophysiology. 2008;45:148–151.
    1. Balconi M, Cotelli M, Brambilla M, Manenti R, Cosseddu M, Premi E, Gasparotti R, Zanetti O, Padovani A, Borroni B. Understanding emotions in frontotemporal dementia: the explicit and implicit emotional cue mismatch. J Alzheimers Dis. 2015;46:211–225.
    1. Belfi AM, Chen K, Schneider B, Tranel D. Neurological damage disrupts normal sex differences in psychophysiological responsiveness to music. Psychophysiology. 2016;53:14–20.
    1. Joshi A, Mendez MF, Kaiser N, Jimenez E, Mather M, Shapira JS. Skin conductance levels may reflect emotional blunting in behavioral variant frontotemporal dementia. J Neuropsychiatry Clin Neurosci. 2014;26:227–232.
    1. Boucsein W. Boston, MA: Springer US; 2012. Electrodermal Activity (electronic resource)

Source: PubMed

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