JMIR Publications

ABSTRACT

Background:

Aging veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer’s dementia (AD), which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive decline in older adults.

Objective:

To evaluate the feasibility and acceptability of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to identify mild cognitive and instrumental activities of daily living (IADL) impairments that are not well captured by clinic-based assessment methods in an aging veteran sample.

Methods:

Participants include 30 community-dwelling veterans, classified as healthy controls (M age = 72.8, SD = 4.9, n = 15) or MCI (M age = 74.3, SD = 6.0, n = 15) using the Clinical Dementia Rating Scale (CDR). Participants were in relatively good health (M modified Cumulative Illness Rating Scale score = 23.1, SD = 2.9) without evidence of depression (M Geriatrics Depression Scale score =1.3, SD = 1.6) or anxiety (M Generalized Anxiety Questionnaire = 1.3, SD = 1.3) on self-report measures. Participants are clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data are collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits.

Results:

Enrollment began in October 2018 and continued until the study groups were filled in January 2019. Two hundred and one people called to participate following public posting and focused mailings. Most common exclusionary criteria included non-veteran status (11%), living too far from the study site (9%), and having exclusionary health concerns (18%). Five people have withdrawn from the study; two with unanticipated health conditions, two living in a vacation home for more than half of the year, and one who saw no direct benefit from the research study. At baseline, MCI participants had lower MoCA (P < .001) and higher FAQ scores (P = .04) than healthy controls. Over seven months, research personnel visited participant’s homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P = .04) than healthy controls, and the most common device needing maintenance was the instrumented pillbox.

Conclusions:

Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used within the VA system to monitor cognition and daily functioning in aging veterans.