Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 18, 2023
Date Accepted: Apr 19, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: A Systematic Review
ABSTRACT
Background:
Subtle impairments in instrumental activities of daily living (IADL) can be a key predictor of disease progression and are considered central to functional independence. Mild cognitive impairment (MCI) is a syndrome associated with significant changes in cognitive function and mild impairment in complex functional abilities. Early detection of functional decline through identification of IADL impairments can aid early intervention strategies. Digital health technology is an objective method of capturing IADL related behaviours. However, it is unclear how these IADL related behaviours have been digitally assessed in the literature, and what differences can be observed between MCI and normal ageing.
Objective:
This review aimed to identify digital methods and metrics used to assess IADL related behaviours in MCI, and report any significant differences in these digital endpoints between MCI and normal ageing, and how they may change over time.
Methods:
A total of 16,099 titles were identified from eight databases (CINAHL, Embase, Medline, ProQuest, PsycInfo, PubMed, Web of Science and Scopus), with 15 included in this review. Included studies must have used continuous, remote, digital measures to assess IADL-related behaviours in adults characterised as having MCI by clinical diagnosis or assessment. This review was registered on PROSPERO (CRD42022326861) and conducted in accordance with the PRISMA guidelines.
Results:
Ambient technology was the most commonly used digital method to assess IADL related behaviours (93% of included studies), with PIR motion sensors (33%) and contact sensors (33%) the most prevalent type of method. Digital technologies were used to assess IADL related behaviours across five domains: ‘Activities Outside of the Home’, ‘Everyday Technology Use’, ‘Household and Personal Management’, ‘Medication Management’, and ‘Orientation’. Other recognised domains ‘Culturally Specific Tasks’ and ‘Socialisation and Communication’ were not assessed. Seventy-nine metrics were recorded between 11 types of technology, with 65 metrics used only once. There were inconsistent findings around differences in digital IADL endpoints across the cognitive spectrum, with limited longitudinal assessment of how they changed over time.
Conclusions:
Despite the broad range of metrics and methods used to digitally assess IADL related behaviours in MCI, several IADLs relevant to functional decline were not studied. Measuring multiple IADL related digital endpoints could offer more value than the measurement of discrete IADL outcomes alone to observe functional decline. Key recommendations include the development of suitable core metrics relevant to IADL related behaviours that are based on clinically-meaningful outcomes to aid standardisation, and further validation of digital technologies against existing IADL measures. Increased longitudinal monitoring is necessary to capture changes in digital IADL endpoints over time in MCI.
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