Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group.

BACKGROUND: Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies. METHODS: The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France). RESULTS: Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient's previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient's environment (Criterion D). CONCLUSIONS: The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.

Accuracy and reliability of the RGB-D camera for measuring walking speed on a treadmill.

AIM: RGB-D cameras (Red Green Blue+Depth) are widely employed in exergames designed to physically stimulate elderly people. Nevertheless, the intensity of the physical activity reached with the existing solutions is rarely sufficient to obtain a real impact on the physical fitness and thus on the health status of this population. In this context, a Point Cloud Based System (PCBS) has been developed to interface ordinary motorized treadmills with exergames through a simple RGB-D camera, to induce players to perform physical activities at higher intensities. The goal of this study was to assess the accuracy and reliability of PCBS to measure the walking speed of a subject on a standard motorized treadmill based on the image streams of an RGB-D camera. METHODS: 36 participants performed three 10min walking exercises, divided in 5 blocks of 2min at the following constant ordered speeds: 0.42, 0.69, 0.97, 1.25 and 1.53ms(-1). The measured walking speeds are compared to those obtained through a Marker Based Control System (MBCS). RESULTS: Results showed a high system accuracy (bias: 0.013±0.015ms(-1)), a good reliability (ICC=0.63-0.91) and a low variability (SEM=1-5%; MD=2.7-14%). DISCUSSION: Accuracy and reliability of PCBS are consistent with those obtained in similar existing systems measuring gait parameters. CONCLUSION: Within the context of the development of exergames, PCBS may be combined with exergames to perform physical activities at sufficiently high intensities in the elderly population, in order to improve their physical health and possibly prevent/delay cognitive impairment.

Recommendations for ICT use in Alzheimer's disease assessment: Monaco CTAD Expert Meeting.

Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care providers, and also provide better tools for clinical research. In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association. The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.

Automatic video monitoring system for assessment of Alzheimer's disease symptoms.

In order to fully capture the complexity of the behavioural, functioning and cognitive disturbances in Alzheimer Disease (AD) and related disorders information and communication techniques (ICT), could be of interest. This article presents using 3 clinical cases the feasibility results of an automatic video monitoring system aiming to assess subjects involved in a clinical scenario. METHOD AND POPULATION: The study was conducted in an observation room equipped with everyday objects for use in activities of daily living. The overall aim of the clinical scenario was to enable the participants to undertake a set of daily tasks that could realistically be achieved in the setting of the observation room. The scenario was divided in three steps covering basic to more complex activities: (1) Directed activities, (2) Semi-directed activities, (3) Undirected ("free") activities. The assessment of each participant of the study was done with an automatic video monitoring system composed of a vision component and an event recognition component. The feasibility study involved three participants: two AD patients and one elderly control participant. RESULTS: The first result of the study was to demonstrate the feasibility of this new assessment method from both the patient and the technical points of view. During the first step the control participant performed all these activities faster than the two AD participants. During the second step of the scenario AD participants were not able to follow the correct order of the tasks and even omitted some of them. Finally during the last step of the scenario devoted to free activities the control participant chose one of the proposed activities (reading) and undertook this activity for almost the entire duration. In contrast, the two AD participants had more difficulties choosing one of the suggested activities and were not able to undertake any one activity in a sustained manner. DISCUSSION: The automatic video monitoring system presented here analyzes human behaviours and looks for changes in activity through the detection of the presence of people and their movements in real time. Once the technique has been standardized, it could significantly enhance the assessment of AD patients in both clinical and clinical trial settings as well as providing further information regarding patient frailty that could enhance their safety and ease caregiver burden.