Abstract
Patients with Alzheimer's disease (AD) and AD related dementias (ADRD) often experience spatial disorientation that can lead to wandering behavior, characterized by aimless or purposeless movement. Wandering behavior has been associated with falls, caregiver burden, and nursing home placement. Despite the substantial clinical consequences of wandering, there is currently no standardized approach to objectively quantify wandering behavior. In this pilot feasibility study, we used a lightweight inertial sensor to examine mobility characteristics of a small group of 12 older adults with ADRD and mild cognitive impairment in their homes. Specifically, we evaluated their compliance with wearing a sensor for a minimum of 4 days. We also examined the ability of the sensor to measure turning frequency and direction changes, given that frequent turns and direction changes during walking have been observed in patients who wander. We found that all patients were able to wear the sensor yielding quantitative turn data including number of turns over time, mean turn duration, mean peak turn speed, and mean turn angle. We found that wanderers make more frequent, quicker turns compared to non-wanderers, which is consistent with pacing or lapping behavior. This study provides preliminary evidence that continuous monitoring in patients with dementia is feasible using a wearable sensor. More studies are needed to explore if objective measures of turning behaviors collected using inertial sensors can be used to identify wandering behavior.
Highlights
People with Alzheimer’s disease (AD) and AD-related dementias (ADRD) can experience impaired spatial awareness and navigation ability, which is thought to lead to wandering behavior [1,2,3,4]
Eligibility criteria included: [1] minimum age of 55 years, [2] a diagnosis of mild cognitive impairment (MCI) or AD based on the 2011 National Institute on Aging—Alzheimer’s Association (NIAAA) criteria [24] or other types of dementia, [3] presence of rank-sum tests were used to determine if there was a difference in various characteristics between non-wanderers and wanderers in a subset of participants
Turning events were defined as a rotation of at least 45 degrees in the horizontal plane [26, 27]
Summary
People with Alzheimer’s disease (AD) and AD-related dementias (ADRD) can experience impaired spatial awareness and navigation ability, which is thought to lead to wandering behavior [1,2,3,4]. There is no standardized approach to objectively describe and measure this behavior. Wandering behavior is typically detected by caregiver report, which may be imprecise, as it is based on the caregiver’s ability to recognize and report this behavior. Various technologies, such as video surveillance, fluorescent dye– based image processing, wearable global positioning systems (GPSs), and electronic tagging, have been used to physically track wandering patients to help prevent elopement [5, 6, 11,12,13,14], but there is currently no standardized approach to objectively measure and quantify the wandering behavior itself
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