Using Continuous Passive Assessment Technology to Describe Health and Behavior Patterns Preceding and Following a Cancer Diagnosis in Older Adults: Proof-of-Concept Case Series Study.

BACKGROUND: Describing changes in health and behavior that precede and follow a sentinel health event, such as a cancer diagnosis, is challenging because of the lack of longitudinal, objective measurements that are collected frequently enough to capture varying trajectories of change leading up to and following the event. A continuous passive assessment system that continuously monitors older adults' physical activity, weight, medication-taking behavior, pain, health events, and mood could enable the identification of more specific health and behavior patterns leading up to a cancer diagnosis and whether and how patterns change thereafter. OBJECTIVE: In this study, we conducted a proof-of-concept retrospective analysis, in which we identified new cancer diagnoses in older adults and compared trajectories of change in health and behaviors before and after cancer diagnosis. METHODS: Participants were 10 older adults (mean age 71.8, SD 4.9 years; 3/10, 30% female) with various self-reported cancer types from a larger prospective cohort study of older adults. A technology-agnostic assessment platform using multiple devices provided continuous data on daily physical activity via wearable sensors (actigraphy); weight via a Wi-Fi-enabled digital scale; daily medication-taking behavior using electronic Bluetooth-enabled pillboxes; and weekly pain, health events, and mood with online, self-report surveys. RESULTS: Longitudinal linear mixed-effects models revealed significant differences in the pre- and postcancer trajectories of step counts (P<.001), step count variability (P=.004), weight (P<.001), pain severity (P<.001), hospitalization or emergency room visits (P=.03), days away from home overnight (P=.01), and the number of pillbox door openings (P<.001). Over the year preceding a cancer diagnosis, there were gradual reductions in step counts and weight and gradual increases in pain severity, step count variability, hospitalization or emergency room visits, and days away from home overnight compared with 1 year after the cancer diagnosis. Across the year after the cancer diagnosis, there was a gradual increase in the number of pillbox door openings compared with 1 year before the cancer diagnosis. There was no significant trajectory change from the pre- to post-cancer diagnosis period in terms of low mood (P=.60) and loneliness (P=.22). CONCLUSIONS: A home-based, technology-agnostic, and multidomain assessment platform could provide a unique approach to monitoring different types of behavior and health markers in parallel before and after a life-changing health event. Continuous passive monitoring that is ecologically valid, less prone to bias, and limits participant burden could greatly enhance research that aims to improve early detection efforts, clinical care, and outcomes for people with cancer.

Preferences of NIA Alzheimer's Disease Research Center participants regarding remote assessment during the COVID-19 pandemic.

Introduction: During the COVID-19 pandemic, in-person research study visits were moved to an online format using a variety of communication platforms (e.g., Webex and Zoom). Increased technology use among older adults allowed for greater insight regarding the remote research study visit format. Methods: A survey developed by the National Alzheimer's Coordinating Center (NACC) was distributed among 12 Alzheimer's Disease Research Centers (ADRCs). The COVID-19 Technology Accessibility Survey aimed to understand preferences of older adults regarding their research study visits and how they accessed the internet. Results: Among 12 ADRCs, 2070 responses were received (mean age: 72.8 years [standard deviation (SD) = 10.4], mean education: 16.6 years [SD = 2.6], race/ethnicity: 85% White/non-Hispanic). Among respondents, those with some form of cognitive impairment were more likely to prefer remote research study visits (mild cognitive impairment [MCI] vs. normal [odds ratio (OR) = 1.40, P = 0.02] and dementia vs. normal [OR = 1.48, P < 0.01]). Respondents with cognitive impairment were also less likely to have interest in smartphone use during at-home study visits (MCI vs. normal [OR = 0.71, P = 0.02] and dementia vs. normal [OR = 0.63, P < 0.001]). Results were similar regarding tablet use (MCI vs. normal [OR = 0.73, P = 0.04] and dementia vs. normal [OR = 0.72, P = 0.01]). Geographical location was analyzed in terms of the percentage of respondents in each region who preferred remote research study visits: West, 51%; Midwest, 34%; South, 41%; and Northeast, 57% (P < 0.0001). Discussion: Results from the study suggest that there is a growing interest in the remote research study visit format. Further studies will allow for greater understanding and development of this research format.

Depressive symptoms in older adult couples: Associations with dyadic physical health, social engagement, and close friends.

Objective: The objective of this study was to examine associations between level of depressive symptoms in older adult spouse/partner couples and their physical health and social factors (social activity and number of close friends). Methods: Using data from 116 community-dwelling couples (age 76.2 ± 8.5), we simultaneously analyzed associations between depressive symptoms (Geriatric Depression Scale, range 0-11) and dyadic physical health, engagement in social activities, and connectedness with close friends. Results: Greater engagement in social activities was associated with fewer depressive symptoms in men, whereas more close friendships were associated with fewer depressive symptoms in women, controlling for partner effects, age, education, and cognitive function, with good model fit. Additionally, more disparate physical health within the couple (latent incongruence score) was associated with greater depressive symptoms in men. Discussion: Less social activity and fewer close friends were associated with depressive symptoms in older adult couples, but may be distinctly influential depending on gender and in the context of the older adult couple's physical health.

Trajectories of cognitive functioning in later life: Disparities by race/ethnicity, educational attainment, sex, and multimorbidity combinations.

Evaluating multimorbidity combinations, racial/ethnic background, educational attainment, and sex associations with age-related cognitive changes is critical to clarifying the health, sociodemographic, and socioeconomic mechanisms associated with cognitive function in later life. Data from the 2011-2018 National Health and Aging Trends Study for respondents aged 65 years and older (N = 10,548, mean age = 77.5) were analyzed using linear mixed effect models. Racial/ethnic differences (mutually-exclusive groups: non-Latino White, non-Latino Black, and Latino) in cognitive trajectories and significant interactions with sex and education (

The Remote Assessment and Dynamic Response Program: Development of an In-Home Dementia-Related Care Needs Assessment to Improve Well-Being.

Background and Objectives: The Remote Assessment and Dynamic Response (READyR) Program was developed in order to address the current lack of early-stage dementia care planning programs that assess the care needs of persons with dementia. The goal was to create a program informed by care values and ongoing ecologically valid data. The objectives of this study are to describe the development and design process of the READyR Program, and to evaluate the utility of the READyR Program for identifying dementia-related care needs. Research Design and Methods: A prototype of the web-based READyR Program tool was first created using digital activity data that were collected by previous studies using a platform of multimodal sensors installed in the homes of older adult couples with and without dementia. Digital activity data were then mapped onto potential care values (e.g., safety & autonomy) to create a values-based needs assessment that is tailored to the individual care dyad. Next, evaluation of the READyR Program by 11 professional dementia care coordinators and case managers (across 3 semistructured focus groups) was used to explore the utility of READyR for assessing dementia-related needs. Qualitative description using conventional content analysis was used to iteratively code focus group data and to describe prevalent themes. Results: Prevalent focus groups themes included barriers to (e.g., family relationship strain) and facilitators of (e.g., tailored assessments) the optimal process for assessing dementia-related care needs by care coordinators, as well as advantages to (e.g., providing new objective insights into function, and routines) and disadvantages of (e.g., bringing up new questions about care) incorporating the remote monitoring data into a values-based needs assessment. Discussion and Implications: READyR has the potential to help family members, as well as care coordinators and providers, gain insight into the values-based care needs of persons with early-stage dementia. Clinical Trials Registration Number: NCT04542109.

Online monitoring of financial capacity in older adults: Feasibility and initial findings.

Introduction: Impairment in financial capacity places older adults at risk of fraud or abuse and can be a harbinger of loss of independence. Online automated monitoring of financial transactions offers an objective, unobtrusive, and continuous data collection strategy to minimize risk and to detect early changes in an important complex activity of daily living. Methods: Ninety-three participants used an online financial activity monitoring platform that extracted metrics related to use and potential departures from established patterns of financial behavior. Standard neuropsychological assessments and a performance-based measure of financial capacity at baseline were compared using continuous monitoring metrics. Results: Participants demonstrated a willingness to engage with an online financial activity monitoring system. Online metrics were not associated with performance in specific cognitive domains. Performance on an established test of financial capacity was negatively correlated with a ratio of alerts to transactions, that is, a higher likelihood of errors or deviations from previous activity. Discussion: To our knowledge, this is the first reported study using secure online technology to link ongoing unobtrusively collected financial activity monitoring data with other objective measures of function and cognition in a cohort of independent living older adults.

Unobtrusive, in-home assessment of older adults' everyday activities and health events: associations with cognitive performance over a brief observation period.

In-home assessment of everyday activities over many months to years may be useful in predicting cognitive decline in older adulthood. This study examined whether a comparatively brief data collection period (3 months) may yield similar diagnostic information. A total of 91 community-dwelling older adults without dementia underwent baseline neuropsychological testing and completed weekly computer-based surveys assessing health-related events/activities. A subset of participants wore fitness tracker watches assessing daily sleep and physical activity patterns, used a sensor-instrumented pillbox, and had their computer use frequency recorded on a daily basis. Similar patterns in computer use, sleep and medication use were noted in comparison to prior literature with more extensive data collection periods. Greater computer use and sleep, as well as self-reported pain and independence, were also linked to better cognition. These activities and symptoms may be useful correlates of cognitive function even when assessed over a relatively brief monitoring period.

Application of In-Home Monitoring Data to Transition Decisions in Continuing Care Retirement Communities: Usability Study.

BACKGROUND: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data. OBJECTIVE: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions. METHODS: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes. RESULTS: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use. CONCLUSIONS: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.

Reproducibility and replicability of high-frequency, in-home digital biomarkers in reducing sample sizes for clinical trials.

INTRODUCTION: Reproducibility and replicability of results are rarely achieved for digital biomarkers analyses. We reproduced and replicated previously reported sample size estimates based on digital biomarker and neuropsychological test outcomes in a hypothetical 4-year early-phase Alzheimer's disease trial. METHODS: Original data and newly collected data (using a different motion sensor) came from the Oregon Center for Aging & Technology (ORCATECH). Given trajectories of those with incident mild cognitive impairment and normal cognition would represent trajectories of the control and experimental groups in a hypothetical trial, sample sizes to provide 80% power to detect effect sizes ranging from 20% to 50% were calculated. RESULTS: For the reproducibility, identical P-values and slope estimates were found with both digital biomarkers and neuropsychological test measures between the previous and current studies. As for the replicability, a greater correlation was found between original and replicated sample size estimates for digital biomarkers (r = 0.87, P < .001) than neuropsychological test outcomes (r = 0.75, P < .001). DISCUSSION: Reproducibility and replicability of digital biomarker analyses are feasible and encouraged to establish the reliability of findings.

Automatic Assessment of Cognitive Tests for Differentiating Mild Cognitive Impairment: A Proof of Concept Study of the Digit Span Task.

BACKGROUND: Current conventional cognitive assessments are limited in their efficiency and sensitivity, often relying on a single score such as the total correct items. Typically, multiple features of response go uncaptured. OBJECTIVES: We aim to explore a new set of automatically derived features from the Digit Span (DS) task that address some of the drawbacks in the conventional scoring and are also useful for distinguishing subjects with Mild Cognitive Impairment (MCI) from those with intact cognition. METHODS: Audio-recordings of the DS tests administered to 85 subjects (22 MCI and 63 healthy controls, mean age 90.2 years) were transcribed using an Automatic Speech Recognition (ASR) system. Next, five correctness measures were generated from Levenshtein distance analysis of responses: number correct, incorrect, deleted, inserted, and substituted words compared to the test item. These per-item features were aggregated across all test items for both Forward Digit Span (FDS) and Backward Digit Span (BDS) tasks using summary statistical functions, constructing a global feature vector representing the detailed assessment of each subject's response. A support vector machine classifier distinguished MCI from cognitively intact participants. RESULTS: Conventional DS scores did not differentiate MCI participants from controls. The automated multi-feature DS-derived metric achieved 73% on AUC-ROC of the SVM classifier, independent of additional clinical features (77% when combined with demographic features of subjects); well above chance, 50%. CONCLUSION: Our analysis verifies the effectiveness of introduced measures, solely derived from the DS task, in the context of differentiating subjects with MCI from those with intact cognition.

An Ecologically Valid, Longitudinal, and Unbiased Assessment of Treatment Efficacy in Alzheimer Disease (the EVALUATE-AD Trial): Proof-of-Concept Study.

BACKGROUND: The current clinical trial assessment methodology relies on a combination of self-report measures, cognitive and physical function tests, and biomarkers. This methodology is limited by recall bias and recency effects in self-reporting and by assessments that are brief, episodic, and clinic based. Continuous monitoring of ecologically valid measures of cognition and daily functioning in the community may provide a more sensitive method to detect subtle, progressive changes in patients with cognitive impairment and dementia. OBJECTIVE: This study aimed to present an alternative trial approach using a home-based sensing and computing system to detect changes related to common treatments employed in Alzheimer disease (AD). This paper introduces an ongoing study that aims to determine the feasibility of capturing sensor-based data at home and to compare the sensor-based outcomes with conventional outcomes. We describe the methodology used in the assessment protocol and present preliminary results of feasibility measures and examples of data related to medication-taking behavior, activity levels, and sleep. METHODS: The EVALUATE-AD (Ecologically Valid, Ambient, Longitudinal and Unbiased Assessment of Treatment Efficacy in Alzheimer's Disease) trial is a longitudinal naturalistic observational cohort study recruiting 30 patients and 30 spouse coresident care partners. Participants are monitored continuously using a home-based sensing and computing system for up to 24 months. Outcome measures of the automated system are compared with conventional clinical outcome measures in AD. Acceptance of the home system and protocol are assessed by rates of dropout and protocol adherence. After completion of the study monitoring period, a composite model using multiple functional outcome measures will be created that represents a behavioral-activity signature of initiating or discontinuing AD-related medications, such as cholinesterase inhibitors, memantine, or antidepressants. RESULTS: The home-based sensing and computing system has been well accepted by individuals with cognitive impairment and their care partners. Participants showed good adherence to the completion of a weekly web-based health survey. Daily activity, medication adherence, and total time in bed could be derived from algorithms using data from the sensing and computing system. The mean monitoring time for current participants was 14.6 months. Medication adherence, as measured with an electronic pillbox, was 77% for participants taking AD-related medications. CONCLUSIONS: Continuous, home-based assessment provides a novel approach to test the impact of new or existing dementia treatments generating objective, clinically meaningful measures related to cognition and everyday functioning. Combining this approach with the current clinical trial methodology may ultimately reduce trial durations, sample size needs, and reliance on a clinic-based assessment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17603.

Improving the Assessment of Mild Cognitive Impairment in Advanced Age With a Novel Multi-Feature Automated Speech and Language Analysis of Verbal Fluency.

Introduction: Clinically relevant information can go uncaptured in the conventional scoring of a verbal fluency test. We hypothesize that characterizing the temporal aspects of the response through a set of time related measures will be useful in distinguishing those with MCI from cognitively intact controls. Methods: Audio recordings of an animal fluency test administered to 70 demographically matched older adults (mean age 90.4 years), 28 with mild cognitive impairment (MCI) and 42 cognitively intact (CI) were professionally transcribed and fed into an automatic speech recognition (ASR) system to estimate the start time of each recalled word in the response. Next, we semantically cluster participant generated animal names and through a novel set of time-based measures, we characterize the semantic search strategy of subjects in retrieving words from animal name clusters. This set of time-based features along with standard count-based features (e.g., number of correctly retrieved animal names) were then used in a machine learning algorithm trained for distinguishing those with MCI from CI controls. Results: The combination of both count-based and time-based features, automatically derived from the test response, achieved 77% on AUC-ROC of the support vector machine (SVM) classifier, outperforming the model trained only on the raw test score (AUC, 65%), and well above the chance model (AUC, 50%). Conclusion: This approach supports the value of introducing time-based measures to the assessment of verbal fluency in the context of this generative task differentiating subjects with MCI from those with intact cognition.

Brain health INnovation Diplomacy: a model binding diverse disciplines to manage the promise and perils of technological innovation.

BACKGROUND: Brain health diplomacy aims to influence the global policy environment for brain health (i.e. dementia, depression, and other mind/brain disorders) and bridges the disciplines of global brain health, international affairs, management, law, and economics. Determinants of brain health include educational attainment, diet, access to health care, physical activity, social support, and environmental exposures, as well as chronic brain disorders and treatment. Global challenges associated with these determinants include large-scale conflicts and consequent mass migration, chemical contaminants, air quality, socioeconomic status, climate change, and global population aging. Given the rapidly advancing technological innovations impacting brain health, it is paramount to optimize the benefits and mitigate the drawbacks of such technologies. OBJECTIVE: We propose a working model of Brain health INnovation Diplomacy (BIND). METHODS: We prepared a selective review using literature searches of studies pertaining to brain health technological innovation and diplomacy. RESULTS: BIND aims to improve global brain health outcomes by leveraging technological innovation, entrepreneurship, and innovation diplomacy. It acknowledges the key role that technology, entrepreneurship, and digitization play and will increasingly play in the future of brain health for individuals and societies alike. It strengthens the positive role of novel solutions, recognizes and works to manage both real and potential risks of digital platforms. It is recognition of the political, ethical, cultural, and economic influences that brain health technological innovation and entrepreneurship can have. CONCLUSIONS: By creating a framework for BIND, we can use this to ensure a systematic model for the use of technology to optimize brain health.

EVALUATE-AD and Tele-STAR: Novel Methodologies for Assessment of Caregiver Burden in a Telehealth Caregiver Intervention - A Case Study.

AIMS: We explored the relationship between objective and subjective measures of burden prior to and after a telehealth-based caregiver intervention. One caregiver participated in two studies, one to assess the feasibility of objective, home-based monitoring (EVALUATE-AD), the second to assess the feasibility of a caregiver education telehealth-based intervention, Tele-STAR. METHODS: Subjective measures of burden and depression in Tele-STAR and objective measures related to daily activities of the caregiver in EVALUATE-AD were compared to examine trends between the different outcome measures. RESULTS: While the caregiver reported an increase in distressing behaviors by her partner, burden levels did not significantly change during or after the Tele-STAR intervention, while objective measures of activity and sleep showed a slight decline. CONCLUSION: Unobtrusive home-based monitoring may provide a novel, objective method to assess the effectiveness of caregiver intervention programs.

A randomized clinical trial to evaluate home-based assessment of people over 75 years old.

INTRODUCTION: There is an unmet need for effective methods for conducting dementia prevention trials. METHODS: Home-based assessment study compared feasibility and efficiency, ability to capture change over time using in-home instruments, and ability to predict cognitive conversion using predefined triggers in a randomized clinical trial in (1) mail-in questionnaire/live telephone interviews, (2) automated telephone/interactive voice recognition, and (3) internet-based computer Kiosk technologies. Primary endpoint was defined as cognitive conversion. RESULTS: Analysis followed a modified intent-to-treat principle. Dropout rates were low and similar across technologies but participants in Kiosk were more likely to dropout earlier. Staff resources needed were higher in Kiosk. In-home instruments distinguished conversion and stable groups. Cognitively stable group showed improvement in cognitive measures. Triggering was associated with higher likelihood of conversion but statistically significant only in mail-in questionnaire/live telephone interviews. DISCUSSION: Relatively low efficiency of internet-based assessment compared with testing by live-assessors has implications for internet-based recruitment and assessment efforts currently proposed for diverse populations.

Targeted Assessment of Enlargement of the Perivascular Space in Alzheimer's Disease and Vascular Dementia Subtypes Implicates Astroglial Involvement Specific to Alzheimer's Disease.

Waste clearance from the brain parenchyma occurs along perivascular pathways. Enlargement of the perivascular space (ePVS) is associated with pathologic features of Alzheimer's disease (AD), although the mechanisms and implications of this dilation are unclear. Fluid exchange along the cerebral vasculature is dependent on the perivascular astrocytic water channel aquaporin-4 (AQP4) and loss of perivascular AQP4 localization is found in AD. We directly measured ePVS in postmortem samples of pathologically characterized tissue from participants who were cognitively intact or had AD or mixed dementia (vascular lesions with AD). We found that both AD and mixed dementia groups had significantly increased ePVS compared to cognitively intact subjects. In addition, we found increased global AQP4 expression of the AD group over both control and mixed dementia groups and a qualitative reduction in perivascular localization of AQP4 in the AD group. Among these cases, increasing ePVS burden was associated with the presence of tau and amyloid-ß pathology. These findings are consistent with the existing evidence of ePVS in AD and provide novel information regarding differences in AD and vascular dementia and the potential role of astroglial pathology in ePVS.

Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial.

INTRODUCTION: Little is known about factors affecting motivation and satisfaction of participants in dementia prevention trials. METHODS: A Research Satisfaction Survey was administered to 422 nondemented older adults who participated in the Home-Based Assessment trial. RESULTS: Overall satisfaction was high, with means of all individual items near to above a value of 3 on a scale from 1 (worst) to 4 (best). Greater satisfaction was associated with staff-administered interviews versus automated technologies. The most liked aspects of research participation were volunteerism, opportunity to challenge and improve mental function, and positive interactions with staff. The least liked aspect was repetitiveness of the assessments. Participants requested more contact with staff and other older adults and more feedback on performance. DISCUSSION: Older adults' participation in research was primarily motivated by altruism. Methodologies that facilitate human contact, encourage feedback and novelty of tasks should be incorporated into future trial design.

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale.

The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

Passive Assessment of Routine Driving with Unobtrusive Sensors: A New Approach for Identifying and Monitoring Functional Level in Normal Aging and Mild Cognitive Impairment.

BACKGROUND: Driving is a key functional activity for many older adults, and changes in routine driving may be associated with emerging cognitive decline due to early neurodegenerative disease. Current methods for assessing driving such as self-report are inadequate for identifying and monitoring subtle changes in driving patterns that may be the earliest signals of functional change in developing mild cognitive impairment (MCI). OBJECTIVE: This proof of concept study aimed to establish the feasibility of continuous driving monitoring in a sample of cognitively normal and MCI older adults for an average of 206 days using an unobtrusive driving sensor and demonstrate that derived sensor-based driving metrics could effectively discriminate between MCI and cognitively intact groups. METHODS: Novel objective driving measures derived from 6 months of routine driving monitoring were examined in older adults with intact cognition (n = 21) and MCI (n = 7) who were enrolled in the Oregon Center for Aging and Technology (ORCATECH) longitudinal assessment program. RESULTS: Unobtrusive continuous monitoring of older adults' routine driving using a driving sensor was feasible and well accepted. MCI participants drove fewer miles and spent less time on the highway per day than cognitively intact participants. MCI drivers showed less day-to-day fluctuations in their driving habits than cognitively intact drivers. CONCLUSION: Sensor-based driving measures are objective, unobtrusive, and can be assessed every time a person drives his or her vehicle to identify clinically meaningful changes in daily driving. This novel methodology has the potential to be useful for the early detection and monitoring of changes in daily functioning within individuals.

Dementia Care Comes Home: Patient and Caregiver Assessment via Telemedicine.

Purpose of the Study: We evaluated the feasibility and reliability of commonly used clinical dementia assessments when administered via direct-to-home telemedicine videoconferencing. To date, few studies assessed the suitability of these measures when used in this setting. Design and Methods: Sixty-six participants (33 patients with Alzheimer's disease (AD) and their 33 caregivers) consented to assessment with a battery of tests in both the clinic setting and via telemedicine. We administered cognitive, behavior, and mood assessments to persons with mild, moderate, and severe AD both in the clinic setting and via direct-to-home telemedicine videoconferencing; test-retest reliability was assessed. We also explored how three caregiver measures performed when administered via telemedicine. Assessments were administered 2 weeks apart. Participant feedback about their experience was solicited. Results: Twenty-eight dyads completed the assessments. Reliability was found to be good to excellent in all measures when used with direct-to-home telemedicine. For the most part, participants and clinicians found telemedicine to be a feasible option for assessing cognitive function and caregiver coping. Implications: Findings indicate that these measures can be used to assess persons with AD, as well as their caregivers, across the telemedicine platform, directly to their homes. Use of this technology can expand access to care to the millions across the United States with AD and their caregivers.