Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: A Systematic Review

Abstract

AbstractBackgroundImpairments in instrumental activities of daily living (IADLs) can be subtle indicators of cognitive decline. By measuring declining IADLs in individuals with Mild Cognitive Impairment (MCI), we may be able to identify those who are at risk of progression to dementia and aid early intervention strategies. Digital technologies (e.g., wearables/ambient sensors) can continuously and objectively assess IADL‐related behaviours. However, it is unclear in the literature what digital methods and metrics have been used to assess IADL‐related behaviours in MCI, and what differences have been observed between MCI and normal ageing. We conducted a systematic review to address this knowledge gap.MethodEight databases (CINAHL/Embase/Medline/ProQuest/PsycInfo/PubMed/Web of Science/Scopus) were searched using key terms. Studies published between 2004‐2022 that used continuous, remote, digital technology to assess IADL‐related behaviours in people with MCI were included. Exclusion criteria included populations with diagnoses of other conditions that may have impacted cognition or function, research conducted in aged‐care facilities, or that had used scripted tasks. IADL‐related behaviours were taken from existing assessments and sorted into relevant domains (e.g., Activities Outside of the Home; Everyday Technology Use). This review was registered with PROSPERO (CRD42022326861) and followed the PRISMA guidelines.ResultFifteen articles were included from 16,099 identified titles. Eleven different technologies were used to assess IADL‐related behaviours, with motion sensors the most common. Ambient technology was used by 93% (n = 14) of studies. Only two studies measured user acceptability of technologies, with >80% of participants providing positive feedback. Seventy‐nine digital metrics were reported; computer use time and time out‐of‐home were the most commonly used. Two studies reported significant decreases in IADLs in the Activities Outside of Home domain for people with MCI compared to normal ageing. Two studies reported significant decreases in Everyday Technology Use, and one study reported a significant decrease in IADLs related to Orientation for people with MCI compared to normal ageing.ConclusionFindings from this review will inform the selection of tools to digitally assess IADL‐related behaviours in populations with MCI. We recommend standardisation and increased validation of digital methods and metrics used to continuously and remotely assess IADLs.