High technology improves Alzheimer's care and diagnosis

Madrid 17 July 2006High tech devices now in development may help compensate for loss of function due to Alzheimer's, enhance care and treatment, and foster independence for people with Alzheimer's and their caregivers, according to new research reported in Madrid at the 10th International Conference on Alzheimer's Disease and Related Disorders (ICAD), presented by the Alzheimer's Association.

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"Innovative uses of high technology offer many exciting possibilities for earlier diagnosis, better care and improved quality of life for people with Alzheimer's and their family members", stated Maria Carrillo, PhD, director of Medical and Scientific Relations at the Alzheimer's Association. "We now are discovering ways to use available advanced technologies to save health care costs, ease caregiver stress, and help people with Alzheimer's live better, safer, more fulfilling lives."

"Most of the methods for diagnosis, treatment and care for Alzheimer's are based on techniques developed decades ago", stated Jeffrey Kaye, MD, chair of the Alzheimer's Association's Working Group on Technology (WGT). "We need to facilitate technology-based research and application in Alzheimer's, and bring the field up to date."

According to Dr. Kaye, who is professor of neurology and biomedical engineering at the Oregon Health and Science University (OHSU) School of Medicine in Portland, and director of the Oregon Center for Aging and Technology, a wide array of new technologies and methods for assessing and treating patients and helping families is emerging that take advantage of rapid developments in communications and monitoring technologies, such as biosensors and bodily diagnostics, activity sensors and behavioural diagnostics, displays, robotics and assistive devices.

Dr. Kaye delivered an update on WGT activities at ICAD. The WGT is a group of investigators and stakeholders interested in facilitating a future where technology will materially help people with Alzheimer's. It grew from the Association's Everyday Technologies for Alzheimer's Care (ETAC) initiative, which is a research funding effort of the Alzheimer's Association, Intel Corporation, and Agilent Technologies.

Identifying memory and movement changes that are early signs of Alzheimer's may allow elders and their families to be pro-active about seeking diagnosis, initiating therapies and planning for the life changes that accompany the disease. Tamara Hayes, PhD, of OHSU, and colleagues focused their research on using unobtrusive technologies to monitor those changes in the home in a study called "A Novel Marker of Mild Cognitive Impairment" and funded by NIA/NIH.

Small motion sensors were used to continuously measure walking speed and overall activity in the home of seven healthy seniors and seven with mild cognitive impairment (MCI) for up to 60 consecutive weeks. The volunteers were not required to do anything except go about their daily business. Walking speed was estimated using sensors along a hall in each home.

The researchers found that the MCI participants had longer walking times than the healthy elderly group. Furthermore, the elders with MCI had more variability in their activity during the day, as compared to the healthy elders. These results are consistent with clinic-based studies of motor changes preceding dementia. However, unlike clinic-based studies in which the differences were identified using measures taken over many years, these differences were detectable in the home using unobtrusive assessment techniques after only four weeks of monitoring.

"Continuous assessment of key thinking, memory and movement skills provides an opportunity to identify early signs of impairment", Dr. Hayes stated. "This study provides the first indication of how continuous, unobtrusive monitoring may be used to assess clinically relevant motor behaviours that relate to cognitive change."

Maintaining cognitive performance is a key factor influencing elders' ability to live independently with a high quality of life. Taking advantage of growing use of computers by seniors, Holly Jimison, PhD, and colleagues from OHSU and Spry Learning Company have developed computer games that can monitor cognitive performance on a routine basis at home. This study is entitled "Novel Computer Methods for Home Monitoring of Cognitive Performance" and is funded by Intel Corporation, Oregon's Roybal Center for Aging and Technology, NIA/NIH, and the National Institute on Standards and Technology's Advanced Technology Projects Programme.

Over several weeks, the investigators evaluated nine people with an average age of 80 years, who frequently played a newly-developed research version of FreeCell, a Solitaire-like game requiring varying degrees of planning ability. Three of the participants had MCI.

By comparing seniors' results on the game to a computer-generated minimal number of moves to solve the puzzle, the researchers were able to correctly distinguish study participants with MCI from the cognitively healthy seniors.

The researchers also found that the performance of people with MCI in the study was highly variable from day to day, while the cognitively healthy elders were more consistent. When they measured average day-to-day variability, they found that it was a powerful indicator of cognitive function.

"Though this is a small number of patients and these are early results, we believe we have a promising technique for early detection of mild cognitive impairment that is also fun for seniors to do on a daily basis", Dr. Jimison stated. "These frequent measures of cognitive performance allow us to look for short-term and long-term trends in a specific individual. We have developed additional computer games to monitor a variety of thinking and memory functions, which we plan to test."

Glenn Smith, PhD, and colleagues from the Mayo Clinic-Rochester, Minnesota, observed that 30 to 40 percent of people with Alzheimer's are living alone at the time they are diagnosed. Dementia can impair a person's ability to properly take their medicine - known as "compliance" - and this issue regularly plays an important part in the decision to move patients to a residential care setting.

Dr. Smith's team investigated whether interactive video monitoring for persons with mild dementia who live alone, or who spend a significant amount of their day alone, could improve their ability to take medicine correctly and improve their mood in a study called "Telehealth Home Monitoring of Solitary Persons with Mild Dementia", funded by the Mayo Foundation, Minnesota Department of Human Services.

The researchers used two-way interactive video technology to provide virtual supervision of 12 patients with mild dementia. They contacted the participants each time they were to take their medications or have their meals. During the two-year study, more than 4000 contacts were made. Once per month, an independent evaluator went into the home to assess whether the patient had taken the appropriate amount of medication. The scientists compared their findings with 12 other participants who received no video monitoring.

In the video-monitored group, people took their medication correctly 81 percent of the time compared to 66 percent in the control group. Comparison of compliance from beginning of monitoring to the end of the programme revealed that video-monitored participants' compliance remained stable while unmonitored patients' compliance fell 12 percentage points, which is consistent with expectations for people with dementia.

"These preliminary findings suggest that a high technology solution can help people with early dementia who are living alone take their medicine correctly", Dr. Smith stated. "We also found that people with mild dementia could be monitored at home without technical difficulty. In the future, we hope to assess whether this technology can help people with mild dementia remain at home for a longer time."

Research shows that people who are regularly engaged in social interaction better maintain their brain vitality as they age. Margaret E. Morris, Ph.D., a clinical psychologist and health technology researcher in Intel's Digital Health Group, and colleagues are developing and testing new technologies that they hope will enable senior citizens to remain socially engaged. Their study is entitled "Motivating Social Engagement Among Elders with Affective Technologies" and is funded by Intel.

In a three-month pilot study, the researchers deployed "social health systems" in the homes of six seniors, two of whom had MCI, and their caregivers who lived separately. They included the following displays:

  • Visual prompts by the telephone that showed seniors the caller's name, picture, relationship, and reminders about their last interaction. This was intended to help seniors recognize callers and pick up the last communication where it left off.
  • "Presence lamps" that gave seniors and their caregivers cues about one another's availability. For instance, a lamp in a daughter's house turned on when her mother sat in her favourite chair. Similarly, a lamp in the mother's home turned on when the daughter came home.
  • Social network visualizations, updated continuously with sensor and journal information, which illustrated the seniors' contact with friends and family using a solar system model and traditional line graphs. The solar system model depicted the senior as the sun; planetary representations of friends and family moved towards and away from the senior depending on their amount of contact.

All participants lived alone and were therefore at risk of isolation. For the first six weeks of the study, wireless sensor networks and an on-line journal were used to assess participants' typical levels of social interaction. In the following six weeks, the three social health displays were introduced into both senior and caregiver homes. Social interaction was assessed through phone calls, visits, outings and e-mail.

The researchers observed that after the social health displays were introduced, both seniors and caregivers paid greater attention to social engagement and expressed increased feelings of closeness. In addition, the total number of phone calls increased, particularly calls from caregivers to seniors.

"Seniors in our study showed more social initiative when they had the social health displays", Dr. Morris stated. "For example, one woman began volunteering at a school, reading to first grade children, as well as reaching out to people in more subtle ways, such as baking cookies when relatives visited. In addition, seniors and caregivers became more attuned to ups and downs in their levels of social contact and expressed readiness to correct downward trends in their mood or social activity. This self-awareness and ability to change feelings of loneliness are critical aspects of social satisfaction and quality of life."

"Important challenges lie ahead for industry, government, and academic researchers, including testing such emerging technologies in clinical trials and making them available to those who could receive the greatest benefit", Dr. Morris stated.

The 10th International Conference on Alzheimer's Disease and Related Disorders (ICAD), presented by the Alzheimer's Association, is the largest gathering of Alzheimer researchers in history. At ICAD 2006, more than 5000 researchers are sharing groundbreaking information and resources on the cause, diagnosis, treatment and prevention of Alzheimer's and related disorders. As a part of the Association's research programme, ICAD serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.

The Alzheimer's Association, the non-profit world leader in Alzheimer's research and support, is the first and largest United States voluntary health organisation dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer's. For more than 25 years, the donor-supported Alzheimer's Association has provided reliable information and care consultation; created supportive services for families; increased funding for dementia research; and influenced public policy changes.


Leslie Versweyveld

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