Abstract
BackgroundAging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults.ObjectiveThis study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample.MethodsParticipants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits.ResultsEnrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants’ homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls.ConclusionsInstallation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples.
Highlights
BackgroundBy year 2050, the number of people living with dementia is projected to triple to 115 million as the world’s aging population continues to grow rapidly [1,2]
The results in this study demonstrate the feasibility of engaging older adult military veterans in an observational research study using in-home instrumental activities of daily living IRB (IADL) monitoring technology
One possible explanation for this finding is that when the devices in the study lost internet connection with the hub computer because of software or firmware updates, healthy control participants were better able to successfully troubleshoot and problem solve technological difficulties remotely over the phone with research staff compared with mild cognitive impairment (MCI) participants, preventing research staff from making additional trips to repair devices
Summary
BackgroundBy year 2050, the number of people living with dementia is projected to triple to 115 million as the world’s aging population continues to grow rapidly [1,2]. The expense related to lifetime dementia care is US $350,174 (in 2018) per person, which is US $150,303 more than the expense for those without dementia [11] As neurodegenerative disorders such as AD progress slowly and over a long period of time [12], early detection of dementia is crucial and has the potential to reduce the number of individuals and caregivers affected by the disease [10]. Identifying individuals with mild cognitive impairment (MCI), which often represents the prodromal stage of several neurodegenerative diseases (including AD) [13], could lead to targeted interventions that improve daily function and independence. Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults
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