Alpha-2-adrenergic receptor agonists for the prevention of delirium and cognitive decline after open heart surgery (ALPHA2PREVENT): protocol for a multicentre randomised controlled trial

INTRODUCTION: Postoperative delirium is common in older cardiac surgery patients and associated with negative short-term and long-term outcomes. The alpha-2-adrenergic receptor agonist dexmedetomidine shows promise as prophylaxis and treatment for delirium in intensive care units (ICU) and postoperative settings. Clonidine has similar pharmacological properties and can be administered both parenterally and orally. We aim to study whether repurposing of clonidine can represent a novel treatment option for delirium, and the possible effects of dexmedetomidine and clonidine on long-term cognitive trajectories, motor activity patterns and biomarkers of neuronal injury, and whether these effects are associated with frailty status. METHODS AND ANALYSIS: This five-centre, double-blind randomised controlled trial will include 900 cardiac surgery patients aged 70+ years. Participants will be randomised 1:1:1 to dexmedetomidine or clonidine or placebo. The study drug will be given as a continuous intravenous infusion from the start of cardiopulmonary bypass, at a rate of 0.4 µg/kg/hour. The infusion rate will be decreased to 0.2 µg/kg/hour postoperatively and be continued until discharge from the ICU or 24 hours postoperatively, whichever happens first.Primary end point is the 7-day cumulative incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Secondary end points include the composite end point of coma, delirium or death, in addition to delirium severity and motor activity patterns, levels of circulating biomarkers of neuronal injury, cognitive function and frailty status 1 and 6 months after surgery. ETHICS AND DISSEMINATION: This trial is approved by the Regional Committee for Ethics in Medical Research in Norway (South-East Norway) and by the Norwegian Medicines Agency. Dissemination plans include publication in peer-reviewed medical journals and presentation at scientific meetings. TRIAL REGISTRATION NUMBER: NCT05029050

AI and Non AI Assessments for Dementia

Current progress in the artificial intelligence domain has led to the development of various types of AI-powered dementia assessments, which can be employed to identify patients at the early stage of dementia. It can revolutionize the dementia care settings. It is essential that the medical community be aware of various AI assessments and choose them considering their degrees of validity, efficiency, practicality, reliability, and accuracy concerning the early identification of patients with dementia (PwD). On the other hand, AI developers should be informed about various non-AI assessments as well as recently developed AI assessments. Thus, this paper, which can be readable by both clinicians and AI engineers, fills the gap in the literature in explaining the existing solutions for the recognition of dementia to clinicians, as well as the techniques used and the most widespread dementia datasets to AI engineers. It follows a review of papers on AI and non-AI assessments for dementia to provide valuable information about various dementia assessments for both the AI and medical communities. The discussion and conclusion highlight the most prominent research directions and the maturity of existing solutions.Comment: 49 page

Automatic detection of disorientation among people with dementia

Ageing is characterized by decline in cognition including visuospatial function, necessary for independently executing instrumental activities of daily living. The onset of Alzheimer’s disease dementia exacerbates this decline, leading to major challenges for patients and increased burden for caregivers. An important function affected by this decline is spatial orientation. This work provides insight into substrates of real-world wayfinding challenges among older adults, with emphasis on viable features aiding the detection of spatial disorientation and design of possible interventions

Sensor-based evaluation of Circadian motor behavior in people with Dementia. Development and validation of analysis strategies

[ITA]La demenza consiste nel deterioramento, spesso progressivo, dello stato cognitivo di un individuo. Chi è affetto da demenza, presenta alterazioni a livello cognitivo, comportamentale e motorio, ad esempio compiendo gesti ossessivi, ripetitivi, senza uno scopo preciso. La condizione dei pazienti affetti da demenza è valutata clinicamente tramite apposite scale e le informazioni relative al comportamento vengono raccolte intervistando chi se ne occupa, come familiari, il personale infermieristico o il medico curante. Spesso queste valutazioni si rivelano inaccurate, possono essere fortemente influenzate da considerazioni soggettive, e sono dispendiose in termini di tempo. Si ha quindi l'esigenza di disporre di metodiche oggettive per valutare il comportamento motorio dei pazienti e le sue alterazioni patologiche; i sensori inerziali indossabili potrebbero costituire una valida soluzione, per questo scopo. L'obiettivo principale della presente attività di tesi è stato definire e implementare un software per una valutazione oggettiva, basata su sensori, del pattern motorio circadiano, in pazienti affetti da demenza ricoverati in un'unità di terapia a lungo termine, che potrebbe evidenziare differenze nei sintomi della malattia che interessano il comportamento motorio, come descritto in ambito clinico. Lo scopo secondario è stato quello di verificare i cambiamenti motori pre- e post-intervento in un sottogruppo di pazienti, a seguito della somministrazione di un programma sperimentale di intervento basato su esercizi fisici. --------------- [ENG]Dementia involves deterioration, often progressive, of a person's cognitive status. Those who suffer from dementia, present alterations in cognitive and motor behavior, for example performing obsessive and repetitive gestures, without a purpose. The condition of patients suffering from dementia is clinically assessed by means of specific scales and information relating to the behavior are collected by interviewing caregivers, such as the family, nurses, or the doctor. Often it turns out that these are inaccurate assessments that may be heavily influenced by subjective evaluations and are costly in terms of time. Therefore, there is the need for objective methods to assess the patients' motor behavior and the pathological changes; wearable inertial sensors may represent a viable option, so this aim. The main objective of this thesis project was to define and implement a software for a sensor-based assessment of the circadian motor pattern in patients suffering from dementia, hospitalized in a long-term care unit, which could highlight differences in the disease symptoms affecting the motor behavior, as described in the clinical setting. The secondary objective was to verify pre- and post-intervention changes in the motor patterns of a subgroup of patients, following the administration of an experimental program of intervention based on physical exercises

A longitudinal observational study of home-based conversations for detecting early dementia:protocol for the CUBOId TV task

INTRODUCTION: Limitations in effective dementia therapies mean that early diagnosis and monitoring are critical for disease management, but current clinical tools are impractical and/or unreliable, and disregard short-term symptom variability. Behavioural biomarkers of cognitive decline, such as speech, sleep and activity patterns, can manifest prodromal pathological changes. They can be continuously measured at home with smart sensing technologies, and permit leveraging of interpersonal interactions for optimising diagnostic and prognostic performance. Here we describe the ContinUous behavioural Biomarkers Of cognitive Impairment (CUBOId) study, which explores the feasibility of multimodal data fusion for in-home monitoring of mild cognitive impairment (MCI) and early Alzheimer’s disease (AD). The report focuses on a subset of CUBOId participants who perform a novel speech task, the ‘TV task’, designed to track changes in ecologically valid conversations with disease progression. METHODS AND ANALYSIS: CUBOId is a longitudinal observational study. Participants have diagnoses of MCI or AD, and controls are their live-in partners with no such diagnosis. Multimodal activity data were passively acquired from wearables and in-home fixed sensors over timespans of 8–25 months. At two time points participants completed the TV task over 5 days by recording audio of their conversations as they watched a favourite TV programme, with further testing to be completed after removal of the sensor installations. Behavioural testing is supported by neuropsychological assessment for deriving ground truths on cognitive status. Deep learning will be used to generate fused multimodal activity-speech embeddings for optimisation of diagnostic and predictive performance from speech alone. ETHICS AND DISSEMINATION: CUBOId was approved by an NHS Research Ethics Committee (Wales REC; ref: 18/WA/0158) and is sponsored by University of Bristol. It is supported by the National Institute for Health Research Clinical Research Network West of England. Results will be reported at conferences and in peer-reviewed scientific journals

Development of a Sensor-Based Behavioral Monitoring Solution to Support Dementia Care

Background: Mobile and wearable technology presents exciting opportunities for monitoring behavior using widely available sensor data. This could support clinical research and practice aimed at improving quality of life among the growing number of people with dementia. However, it requires suitable tools for measuring behavior in a natural real-life setting that can be easily implemented by others. Objective: The objectives of this study were to develop and test a set of algorithms for measuring mobility and activity and to describe a technical setup for collecting the sensor data that these algorithms require using off-the-shelf devices. Methods: A mobility measurement module was developed to extract travel trajectories and home location from raw GPS (global positioning system) data and to use this information to calculate a set of spatial, temporal, and count-based mobility metrics. Activity measurement comprises activity bout extraction from recognized activity data and daily step counts. Location, activity, and step count data were collected using smartwatches and mobile phones, relying on open-source resources as far as possible for accessing data from device sensors. The behavioral monitoring solution was evaluated among 5 healthy subjects who simultaneously logged their movements for 1 week. Results: The evaluation showed that the behavioral monitoring solution successfully measures travel trajectories and mobility metrics from location data and extracts multimodal activity bouts during travel between locations. While step count could be used to indicate overall daily activity level, a concern was raised regarding device validity for step count measurement, which was substantially higher from the smartwatches than the mobile phones. Conclusions: This study contributes to clinical research and practice by providing a comprehensive behavioral monitoring solution for use in a real-life setting that can be replicated for a range of applications where knowledge about individual mobility and activity is relevant

Smart aging : utilisation of machine learning and the Internet of Things for independent living

Smart aging utilises innovative approaches and technology to improve older adults’ quality of life, increasing their prospects of living independently. One of the major concerns the older adults to live independently is “serious fall”, as almost a third of people aged over 65 having a fall each year. Dementia, affecting nearly 9% of the same age group, poses another significant issue that needs to be identified as early as possible. Existing fall detection systems from the wearable sensors generate many false alarms; hence, a more accurate and secure system is necessary. Furthermore, there is a considerable gap to identify the onset of cognitive impairment using remote monitoring for self-assisted seniors living in their residences. Applying biometric security improves older adults’ confidence in using IoT and makes it easier for them to benefit from smart aging. Several publicly available datasets are pre-processed to extract distinctive features to address fall detection shortcomings, identify the onset of dementia system, and enable biometric security to wearable sensors. These key features are used with novel machine learning algorithms to train models for the fall detection system, identifying the onset of dementia system, and biometric authentication system. Applying a quantitative approach, these models are tested and analysed from the test dataset. The fall detection approach proposed in this work, in multimodal mode, can achieve an accuracy of 99% to detect a fall. Additionally, using 13 selected features, a system for detecting early signs of dementia is developed. This system has achieved an accuracy rate of 93% to identify a cognitive decline in the older adult, using only some selected aspects of their daily activities. Furthermore, the ML-based biometric authentication system uses physiological signals, such as ECG and Photoplethysmogram, in a fusion mode to identify and authenticate a person, resulting in enhancement of their privacy and security in a smart aging environment. The benefits offered by the fall detection system, early detection and identifying the signs of dementia, and the biometric authentication system, can improve the quality of life for the seniors who prefer to live independently or by themselves

Ambient assisted living deployment aims to empower people living with dementia (AnAbEL)

Ambient Assisted Living aims to support the wellbeing of people with special needs by offering assistive solutions. Those systems focused on dementia claim to increase the autonomy of people living with dementia by monitoring their activities. Thus, topics such as Activity Recognition related to dementia and specific solutions such as reminders and tracking users by Global Positioning System offer great advances that seek users' safety and to preserve their healthier lifestyle. However, these solutions address secondary parties by providing useful activities logs or alerts but excluding the main interested user: the person living with dementia. Although primary users are taken into consideration at some design stages by using user-centred design frameworks, final products tend not to fully address the user's needs. This paper presents an Ambient Intelligent system aimed to reduce this limitation by developing a final solution more strongly focused on enhancing a healthy lifestyle by empowering the user's autonomy. Through continued activities monitoring in real-time, the system can provide reminders to the users by coaching them to keep healthy routines. Continuous monitoring also provides a complete user's behaviour tracking and the context-awareness logic used involves the caregivers through alerts when necessary to ensure the user's safety. This article describes the process followed to develop the system aimed to cover the previous concerns and the practical feedback from health professionals over the system deployment working in a real environment

Comparison of subjective and physiological stress levels in home and office work environments

Work stress is a major problem to individuals and society, with prolonged periods of stress often leading to health issues and reduced productivity. COVID-19 has increased the incidence of individuals working in a mixture of home and office-based environments, with each location presenting its own stressors. Identification of stress levels in each environment will allow individuals to better plan how to mitigate stress and boost productivity. In this project, differences in stress levels are predicted in each work environment from individuals’ physiological responses and subjectively reported stress and productivity. Initial work on the project focused upon development of a system for the detection of dementia-related difficulties through the wearable-based tracking of physiological indicators. As such, a review of the available commercial and laboratory devices available for tracking physiological indicators of dementia-related difficulties was conducted. Furthermore, no publicly available physiological dataset for predicting difficulties in dementia currently exists. However, a review of the methods for collecting such a dataset and the impact of COVID-19 found that it is impractical and potentially unethical to conduct an experiment with people with dementia during the pandemic. As such, a pivot in research was necessitated. Comparing the stress levels of individuals working in home and office environments was selected. A data collection experiment was then performed with 13 academics working in combinations of home and office environments. Descriptive statistical features were then extracted from both the physiological and questionnaire data, with the relationships between attributes and features calculated using various advanced data analytics and statistical approaches. The resultant correlation coefficients and statistical summaries of stress were used to evaluate relationships between stress and work environment at different times of day, different days of the week, and while performing different activities. A bagged tree machine learning model was trained over the data, achieving 99.3% accuracy when evaluated using 10-fold cross validation. When tested on the purely unseen instances it achieved 56% accuracy corresponding to inter-class stress classification, however a testing accuracy of 73.7% was achieved using principal component analysis for dimensionality reduction and the dataset is balanced using Synthetic Minority Oversampling Technique