Evaluation of daily walking activity and gait profiles: a novel application of a time series analysis framework

Wearable technology allows an in-depth analysis of gait behaviour in free-living environments. This investigation aimed to use Alzheimer's disease as an example to apply the time series analysis technique of Statistical Parametric Mapping (SPM) to create daily gait profiles and test if they differed from cognitively intact controls. A framework of macro (habitual walking behaviours) and micro characteristics (spatiotemporal gait variables) characteristics were calculated on an hourly basis. SPM showed that select micro gait characteristics differed from controls at specific hours of the day. Therefore, the application of SPM may provide a more in-depth reflection of activity and gait time-dependent fluctuations than commonly used whole day values. Considering macro and micro gait hour-by- hour may have applications towards disease management, personalized care, monitoring medication and targeted interventions for people with a range of neurodegenerative diseases

Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic

Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using 'positive' styles and the protective use of 'negative' disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support

Emotion-Focused Dyadic Coping Styles used by Family Carers of People with Dementia during the COVID-19 Pandemic

Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using ‘positive’ styles and the protective use of ‘negative’ disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support

Instrumental activities of daily living scales to detect cognitive impairment and dementia in low- and middle income countries: a systematic review

Background: The largest proportion of people with dementia worldwide live in lowand middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). Objective: This review aimed to identify IADL measures which are specifically developed, validated or adapted for use in LMICs to guide selection of such tools. Methods: A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. Results: 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n=6), translated and adapted for cultural differences (n=6), or newly developed for target LMIC populations (n=7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. Conclusion: Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures

Artificial intelligence for dementia—applied models and digital health

The use of applied modelling in dementia risk prediction, diagnosis, and prognostics will have substantial public health benefit, particularly as ‘deep phenotyping’ cohorts with multi-omics health data become available. This narrative review synthesizes understanding of applied models and digital health technologies, in terms of dementia risk prediction, diagnostic discrimination, prognosis and progression. Machine learning approaches show evidence of improved predictive power compared to standard clinical risk-scores in predicting dementia, and the potential to decompose large numbers of variables into relatively few critical predictors. This review focusses on key areas of emerging promise including: emphasis on easier, more transparent data sharing and cohort access, integration of high-throughput biomarker and electronic health record data into modelling, and progressing beyond primary prediction of dementia to secondary outcomes e.g., treatment response and physical health. Such approaches will benefit also from improvements in remote data measurement, whether cognitive (e.g. online), or naturalistic (e.g. watch-based accelerometry).This paper was the product of a DEMON Network state of the science symposium entitled “Harnessing Data Science and AI in Dementia Research” funded by Alzheimer’s Research UK. AK is supported in part by the NIHR AI Award (AI_AWARD02183). CL is funded by Alzheimer’s Society and Alzheimer’s Research UK. ELH is supported by the Cambridge British Heart Foundation Centre of Research Excellence (RE/18/1/34212). MHI is supported by the UK Research and Innovation-funded DATAMIND project (MR/W014386/1). ET (National Institute for Health Research (NIHR) Clinical Lectureship) is funded by the NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care. JMR and DJL are supported by Alzheimer’s Research UK and the Alan Turing Institute/Engineering and Physical Sciences Research Council (EP/N510129/1). DJL also receives funding from the Medical Research Council (MR/X005674/1), National Institute for Health Research (NIHR) Applied Research Collaboration South West Peninsula, National Health and Medical Research Council (NHMRC), and National Institute on Aging/National Institutes of Health (RF1AG055654)

Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic

Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using 'positive' styles and the protective use of 'negative' disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support