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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Davidoff H, Van den Bulcke L, Vandenbulcke M, De Vos M, Van den Stock J, Van Helleputte N, Van Hoof C, Van Den Bossche MJA. Toward Quantification of Agitation in People With Dementia Using Multimodal Sensing. Innov Aging 2022; 6:igac064. [PMID: 36600807 PMCID: PMC9799041 DOI: 10.1093/geroni/igac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Objectives Agitation, a critical behavioral and psychological symptom in dementia, has a profound impact on a patients' quality of life as well as their caregivers'. Autonomous and objective characterization of agitation with multimodal systems has the potential to capture key patient responses or agitation triggers. Research Design and Methods In this article, we describe our multimodal system design that encompasses contextual parameters, physiological parameters, and psychological parameters. This design is the first to include all three of these facets in an n > 1 study. Using a combination of fixed and wearable sensors and a custom-made app for psychological annotation, we aim to identify physiological markers and contextual triggers of agitation. Results A discussion of both the clinical as well as the technical implementation of the to-date data collection protocol is presented, as well as initial insights into pilot study data collection. Discussion and Implications The ongoing data collection moves us toward improved agitation quantification and subsequent prediction, eventually enabling just-in-time intervention.
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Affiliation(s)
- Hannah Davidoff
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,CSH (Circuits and Systems for Health) - imec, Heverlee, Belgium
| | - Laura Van den Bulcke
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium,Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium,Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Center for Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | | | - Chris Van Hoof
- Department of Electrical Engineering (ESAT), KU Leuven, Heverlee, Belgium,imec OnePlanet, Wageningen, Netherlands
| | - Maarten J A Van Den Bossche
- Address correspondence to: Maarten J. A. Van Den Bossche, MD, PhD, Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, Herestraat 49, 3000 Leuven, Belgium. E-mail:
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Tronstad C, Amini M, Bach DR, Martinsen OG. Current trends and opportunities in the methodology of electrodermal activity measurement. Physiol Meas 2022; 43. [PMID: 35090148 DOI: 10.1088/1361-6579/ac5007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/28/2022] [Indexed: 11/12/2022]
Abstract
Electrodermal activity (EDA) has been measured in the laboratory since the late 1800s. Although the influence of sudomotor nerve activity and the sympathetic nervous system on EDA is well established, the mechanisms underlying EDA signal generation are not completely understood. Owing to simplicity of instrumentation and modern electronics, these measurements have recently seen a transfer from the laboratory to wearable devices, sparking numerous novel applications while bringing along both challenges and new opportunities. In addition to developments in electronics and miniaturization, current trends in material technology and manufacturing have sparked innovations in electrode technologies, and trends in data science such as machine learning and sensor fusion are expanding the ways that measurement data can be processed and utilized. Although challenges remain for the quality of wearable EDA measurement, ongoing research and developments may shorten the quality gap between wearable EDA and standardized recordings in the laboratory. In this topical review, we provide an overview of the basics of EDA measurement, discuss the challenges and opportunities of wearable EDA, and review recent developments in instrumentation, material technology, signal processing, modeling and data science tools that may advance the field of EDA research and applications over the coming years.
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Affiliation(s)
- Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Sognsvannsveien 20, Oslo, 0372, NORWAY
| | - Maryam Amini
- Physics, University of Oslo Faculty of Mathematics and Natural Sciences, Sem Sælands vei 24, Oslo, 0371, NORWAY
| | - Dominik R Bach
- Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, London, WC1N 3AZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Iaboni A, Spasojevic S, Newman K, Schindel Martin L, Wang A, Ye B, Mihailidis A, Khan SS. Wearable multimodal sensors for the detection of behavioral and psychological symptoms of dementia using personalized machine learning models. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12305. [PMID: 35496371 PMCID: PMC9043905 DOI: 10.1002/dad2.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/15/2022]
Abstract
Introduction Behavioral and psychological symptoms of dementia (BPSD) signal distress or unmet needs and present a risk to people with dementia and their caregivers. Variability in the expression of these symptoms is a barrier to the performance of digital biomarkers. The aim of this study was to use wearable multimodal sensors to develop personalized machine learning models capable of detecting individual patterns of BPSD. Methods Older adults with dementia and BPSD (n = 17) on a dementia care unit wore a wristband during waking hours for up to 8 weeks. The wristband captured motion (accelerometer) and physiological indicators (blood volume pulse, electrodermal activity, and skin temperature). Agitation or aggression events were tracked, and research staff reviewed videos to precisely annotate the sensor data. Personalized machine learning models were developed using 1‐minute intervals and classifying the presence of behavioral symptoms, and behavioral symptoms by type (motor agitation, verbal aggression, or physical aggression). Results Behavioral events were rare, representing 3.4% of the total data. Personalized models classified behavioral symptoms with a median area under the receiver operating curve (AUC) of 0.87 (range 0.64–0.95). The relative importance of the different sensor features to the predictive models varied both by individual and behavior type. Discussion Patterns of sensor data associated with BPSD are highly individualized, and future studies of the digital phenotyping of these behaviors would benefit from personalization.
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Affiliation(s)
- Andrea Iaboni
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Sofija Spasojevic
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | | | - Angel Wang
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | - Bing Ye
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Alex Mihailidis
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Shehroz S. Khan
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Institute of Biomaterials & Biomedical Engineering University of Toronto Toronto Ontario Canada
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Webster L, Costafreda Gonzalez S, Stringer A, Lineham A, Budgett J, Kyle S, Barber J, Livingston G. Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep 2021; 43:5601416. [PMID: 31633188 PMCID: PMC7157185 DOI: 10.1093/sleep/zsz251] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Study Objectives Sleep disturbances are a feature in people living with dementia, including getting up during the night, difficulty falling asleep, and excessive daytime sleepiness and may precipitate a person with dementia moving into residential care. There are varying estimates of the frequency of sleep disturbances, and it is unknown whether they are a problem for the individual. We conducted the first systematic review and meta-analysis on the prevalence and associated factors of sleep disturbances in the care home population with dementia. Methods We searched Embase, MEDLINE, and PsycINFO (29/04/2019) for studies of the prevalence or associated factors of sleep disturbances in people with dementia living in care homes. We computed meta-analytical estimates of the prevalence of sleep disturbances and used meta-regression to investigate the effects of measurement methods, demographics, and study characteristics. Results We included 55 studies of 22,780 participants. The pooled prevalence on validated questionnaires of clinically significant sleep disturbances was 20% (95% confidence interval, CI 16% to 24%) and of any symptom of sleep disturbance was 38% (95% CI 33% to 44%). On actigraphy using a cutoff sleep efficiency of <85% prevalence was 70% (95% CI 55% to 85%). Staff distress, resident agitation, and prescription of psychotropic medications were associated with sleep disturbances. Studies with a higher percentage of males had a higher prevalence of sleep disturbance. Conclusions Clinically significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics. Actigraphy appears to offer no benefit over proxy reports in this population.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
- Corresponding author. Lucy Webster, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Amy Lineham
- University College London Medical School, London, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, UK
| | - Simon Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Ozdemir D, Cibulka J, Stepankova O, Holmerova I. Design and implementation framework of social assistive robotics for people with dementia - a scoping review. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sefcik JS, Ersek M, Libonati JR, Hartnett SC, Hodgson NA, Cacchione PZ. Heart Rate of Nursing Home Residents with Advanced Dementia and Persistent Vocalizations. HEALTH AND TECHNOLOGY 2020; 10:827-831. [PMID: 32467819 DOI: 10.1007/s12553-019-00397-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent vocalizations (PVs) are a common behavioral symptom of dementia. There are currently no known studies examining physiological measurement in nursing home (NH) residents with dementia exhibiting PVs. Measures of heart rate (HR) could provide objective evidence of a person's response to a disruption in their internal or external environment. This was a two-case observational study involving NH residents with advanced dementia. HRs were collected via a sensor belt. We found a 39-45 bpm increase in HRs in both participants when comparing a day without PVs to a day exhibiting PVs. This is the first study to demonstrate a change in HR associated with PVs and potential evidence of stress in the person in response to either an internal or external stimuli.
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Affiliation(s)
- Justine S Sefcik
- Drexel University College of Nursing and Health Professions, 1601 Cherry St., Room 230, Philadelphia, PA 19102
| | - Mary Ersek
- Department of Veterans Affairs, Philadelphia, PA
| | - Joseph R Libonati
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Sasha C Hartnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
| | - Pamela Z Cacchione
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104
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Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020; 10:1699. [PMID: 32116687 PMCID: PMC7011129 DOI: 10.3389/fphar.2019.01699] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia. Methods The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3rd of May 2019. Results A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted. Conclusions Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation. Systematic Review Registration PROSPERO, identifier CRD42019134313.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Hannah L Heintz
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Praise Owoyemi
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Aniqa T Rahman
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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