Monitoring Behaviors of Patients with Late-stage Dementia Using Passive Environmental Sensing Approaches: A Case Series

Abstract Objectives To show the feasibility of using different unobtrusive activity-sensing technologies to provide objective behavioral markers of patients with dementia (PwD). Design Monitored the behaviors of two PwD living in memory care unit using the Oregon Center for Aging & Technology (ORCATECH) platform, and the behaviors of two PwD living in assisted living facility using the Emerald device. Setting A memory care unit in Portland, Oregon and an assisted living facility in Framingham, Massachusetts. Participants A 63-year-old male with Alzheimer's disease (AD), and an 80-year-old female with frontotemporal dementia, both lived in a memory care unit in Portland, Oregon. An 89-year-old woman with a diagnosis of AD, and an 85-year-old woman with a diagnosis of major neurocognitive disorder, Alzheimer's type with behavioral symptoms, both resided at an assisted living facility in Framingham, Massachusetts. Measurements These include: sleep quality measured by the bed pressure mat; number of transitions between spaces and dwell times in different spaces measured by the motion sensors; activity levels measured by the wearable actigraphy device; and couch usage and breathing amplitudes measured by the Emerald device. Results Number of transitions between spaces can identify the patient's episodes of agitation; activity levels correlate well with the patient's excessive level of agitation and lack of movement when the patient received potentially inappropriate medication and neared the end of life; couch usage can detect the patient's increased level of apathy; and breathing amplitude can help detect risperidone-induced periodic limb motion. This is the first demonstration that the ORCATECH platform and the Emerald device can measure such activities. Conclusions The use of technologies for monitoring behaviors of PwD can provide more objective and intensive measurements of PwD behaviors.