Extended, continuous measures of functional status in community dwelling persons with Alzheimer’s and related dementia: Infrastructure, performance, tradeoffs, preliminary data, and promise

• Published in: Journal of neuroscience methods Vol. 300; pp. 59 - 67
• Main Authors: Zylstra, Bradley, Netscher, George, Jacquemot, Julien, Schaffer, Michael, Shen, Galen, Bowhay, Angela D., Braley, Tamara L., Possin, Katherine L., Miller, Bruce L., Bayen, Alexandre M., Bonasera, Stephen J., Schenk, A. Katrin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.04.2018
• Subjects: Activities of Daily Living; Activity; Aged; Aged, 80 and over; Alzheimer Disease - diagnosis; Alzheimer’s disease; Dementia; Dementia - diagnosis; Female; Functional status; Humans; Independent Living; Lifespace; Male; Middle Aged; Mobile Applications; Monitoring, Ambulatory - instrumentation; Monitoring, Ambulatory - methods; Smartphone; Smartwatch; Telemedicine - instrumentation; Telemedicine - methods; Wearable Electronic Devices; Functional status; Lifespace; Alzheimer’s disease; Activity; Smartphone; Smartwatch; Dementia
• ISSN: 0165-0270; 1872-678X
• DOI: 10.1016/j.jneumeth.2017.08.034

•A mobile health platform for daily measures of functional status in community dwelling subjects, including those with neuro degenerative disorders.•We use Smart watches and Smartphones to measure subject overall activity and outdoor location (to derive their life space).•These clinically-relevant measures track a subject’s functional status.•Functional status integrated with medical information and caregiver reports, a care giving team guides referrals for physician/APRN/NP care.•We provide real-world data from current subject enrollees demonstrating system accuracy and reliability. The past decades have seen phenomenal growth in the availability of inexpensive and powerful personal computing devices. Efforts to leverage these devices to improve health care outcomes promise to remake many aspects of healthcare delivery, but remain in their infancy. We describe the development of a mobile health platform designed for daily measures of functional status in ambulatory, community dwelling subjects, including those who have Alzheimer’s disease or related neurodegenerative disorders. Using Smartwatches and Smartphones we measure subject overall activity and outdoor location (to derive their lifespace). These clinically-relevant measures allow us to track a subject’s functional status in their natural environment over prolonged periods of time without repeated visits to healthcare providers. Functional status metrics are integrated with medical information and caregiver reports, which are used by a caregiving team to guide referrals for physician/APRN/NP care. with Existing Methods We describe the design tradeoffs involved in all aspects of our current system architecture, focusing on decisions with significant impact on system cost, performance, scalability, and user-adherence. We provide real-world data from current subject enrollees demonstrating system accuracy and reliability. We document real-world feasibility in a group of men and women with dementia that Smartwatches/Smartphones can provide long-term, relevant clinical data regarding individual functional status. We describe the underlying considerations of this system so that interested organizations can adapt and scale our approach to their needs. Finally, we provide a potential agenda to guide development of future systems.