Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States.
JMIR Hum Factors. 2024 Nov 22;11:e59974. doi: 10.2196/59974.
BACKGROUND: Current methods of monitoring cognition in older adults are insufficient to address the growing burden of Alzheimer disease and related dementias (AD/ADRD). New approaches that are sensitive, scalable, objective, and reflective of meaningful functional outcomes are direly needed. Mobility trajectories and geospatial life space patterns reflect many aspects of cognitive and functional integrity and may be useful proxies of age-related cognitive decline. OBJECTIVE: We investigated the feasibility, acceptability, and preliminary validity of a 1-month smartphone digital phenotyping protocol to infer everyday cognition, function, and mood in older adults from passively obtained GPS data. We also sought to clarify intrinsic and extrinsic factors associated with mobility phenotypes for consideration in future studies. METHODS: Overall, 37 adults aged between 63 and 85 years with healthy cognition (n=31, 84%), mild cognitive impairment (n=5, 13%), and mild dementia (n=1, 3%) used an open-source smartphone app (mindLAMP) to unobtrusively capture GPS trajectories for 4 weeks. GPS data were processed into interpretable features across categories of activity, inactivity, routine, and location diversity. Monthly average and day-to-day intraindividual variability (IIV) metrics were calculated for each feature to test a priori hypotheses from a neuropsychological framework. Validation measures collected at baseline were compared against monthly GPS features to examine construct validity. Feasibility and acceptability outcomes included retention, comprehension of study procedures, technical difficulties, and satisfaction ratings at debriefing. RESULTS: All (37/37, 100%) participants completed the 4-week monitoring period without major technical adverse events, 100% (37/37) reported satisfaction with the explanation of study procedures, and 97% (36/37) reported no feelings of discomfort. Participants' scores on the comprehension of consent quiz were 97% on average and associated with education and race. Technical issues requiring troubleshooting were infrequent, though 41% (15/37) reported battery drain. Moderate to strong correlations (r≥0.3) were identified between GPS features and validators. Specifically, individuals with greater activity and more location diversity demonstrated better cognition, less functional impairment, less depression, more community participation, and more geospatial life space on objective and subjective validation measures. Contrary to predictions, greater IIV and less routine in mobility habits were also associated with positive outcomes. Many demographic and technology-related factors were not associated with GPS features; however, income, being a native English speaker, season of study participation, and occupational status were related to GPS features. CONCLUSIONS: Theoretically informed digital phenotypes of mobility are feasibly captured from older adults' personal smartphones and relate to clinically meaningful measures including cognitive test performance, reported functional decline, mood, and community activity. Future studies should consider the impact of intrinsic and extrinsic factors when interpreting mobility phenotypes. Overall, smartphone digital phenotyping is a promising method to unobtrusively capture relevant risk and resilience factors in the context of aging and AD/ADRD and should continue to be investigated in large, diverse samples.
背景:目前监测老年人认知能力的方法不足以应对阿尔茨海默病和相关痴呆症(AD/ADRD)日益增长的负担。迫切需要新的、敏感的、可扩展的、客观的、反映有意义的功能结果的方法。移动轨迹和地理空间生活空间模式反映了认知和功能完整性的许多方面,可能是与年龄相关的认知能力下降的有用替代指标。
目的:我们研究了使用智能手机数字表型分析方案(通过被动获取 GPS 数据推断老年人日常认知、功能和情绪)在老年人中的可行性、可接受性和初步有效性。我们还试图阐明与移动表型相关的内在和外在因素,以供未来研究考虑。
方法:共有 37 名年龄在 63 至 85 岁之间的认知健康(n=31,84%)、轻度认知障碍(n=5,13%)和轻度痴呆(n=1,3%)的成年人使用开源智能手机应用程序(mindLAMP)在 4 周内不引人注目地捕获 GPS 轨迹。GPS 数据被处理成可解释的活动、不活动、常规和位置多样性等类别的特征。为了测试神经心理学框架中的先验假设,针对每个特征计算了每月平均和每日个体内变异性(IIV)指标。在基线收集的验证措施与每月 GPS 特征进行了比较,以检验结构有效性。可行性和可接受性结果包括保留率、对研究程序的理解、技术困难和汇报时的满意度。
结果:所有(37/37,100%)参与者均在无重大技术不良事件的情况下完成了 4 周的监测期,100%(37/37)报告对研究程序的解释满意,97%(36/37)报告无不适感觉。参与者对同意书测验的理解平均得分 97%,与教育程度和种族有关。需要解决的技术问题很少见,但 41%(15/37)报告电池电量消耗过快。GPS 特征与验证指标之间存在中度至强相关性(r≥0.3)。具体来说,活动量和位置多样性较大的个体表现出更好的认知能力、较少的功能障碍、较少的抑郁、更多的社区参与和更广泛的地理空间生活空间,这些都体现在客观和主观的验证措施上。与预测相反,移动习惯中的 IIV 增加和常规减少也与积极结果相关。许多人口统计学和技术相关因素与 GPS 特征无关;然而,收入、母语是英语、研究参与的季节和职业地位与 GPS 特征有关。
结论:从老年人的个人智能手机中可以合理地获取与理论相关的移动数字表型,这些表型与有意义的临床测量指标相关,包括认知测试表现、报告的功能下降、情绪和社区活动。未来的研究在解释移动表型时应考虑内在和外在因素的影响。总的来说,智能手机数字表型是一种很有前途的方法,可以在老龄化和 AD/ADRD 背景下不引人注目的地捕捉相关风险和适应力因素,应继续在大型、多样化的样本中进行研究。
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