Movement and Memory. Undergraduate degree. Technology & Movement: New Approaches to Understanding Change. Graduate degree

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Tracy Zitzelberger, MPH Technology & Movement: New Approaches to Understanding Change Tracy Zitzelberger, MPH Administra9ve Director Layton Aging & Alzheimer's Disease Center

Tracy Zitzelberger, MPH Aging & Technology Researcher: coordinate & conduct studies Administrator: respond to research requirements and policies Collaborator: work with other staff

Can we predict memory impairment? How can we help seniors live independently as long as possible? How will technology play a role? How do seniors feel about technology?

in variability BEFORE memory problems start Current assessment limits what we can understand Infrequent assessments Conducted at a clinic on provider s schedule Depends on

1 Tracy Zitzelberger, MPH Technology & Movement: New Approaches to Understanding Change Tracy Zitzelberger, MPH Administra9ve Director Layton Aging & Alzheimer's Disease Center Oregon Center for Aging & Technology Undergraduate degree Bachelor of Arts in Women s Studies Chemistry minor Graduate degree Master of Public Health Health Administration & Policy Tracy Zitzelberger, MPH Aging & Technology Researcher: coordinate & conduct studies Administrator: respond to research requirements and policies Collaborator: work with other staff and investigators to foster research Psychometrist: give memory tests Writer: prepare grants and articles for publication How can we better understand changes associated with aging? Can we predict memory impairment? How can we help seniors live independently as long as possible? How will technology play a role? How do seniors feel about technology? Movement and Memory Current practice is limited Key factors in ability to live independently Research indicates a relationship Faster walkers live longer without dementia Increase in variability BEFORE memory problems start Current assessment limits what we can understand Infrequent assessments Conducted at a clinic on provider s schedule Depends on self-report Assumes exam findings represent typical function Hard to track across the course of illness Limited knowledge of other events that effect outcomes (e.g., sleep, socialization, physical activity) 1

2 Measured Function Measured Function Baseline 12 Months 24 Months Baseline 12 Months 24 Months Early detection Change Symptoms Reported Cognitive or Functional Measure Cognitive or Functional Measure Symptoms Reported Response range Continuous Assessment Platform Elements Bed Sensors Actigraphy devices Expand how we assess people! Brief, episodic, clinic-based, obtrusive & inconvenient assessment Real-time, continuous, home-based & unobtrusive assessment Physiological Phone Localization Walking Cell phone as prompting device and for location tracking PC/Kiosk/Etc.: Experience sampling; cognitive testing; social engagement; coaching Activity Door Medication tracking device 2

3 Data Fusion: strength in combining data streams Life Events Life Space Analysis Improved Dementia Assessment & Health Outcomes Data Fusion Spiral plot: The plot is a 24 hour clock representing here 8 weeks of continuous data. At the top of the clock is midnight; at the bottom is noon. Each concentric blue circle outward represents 2 weeks of time. The colors of the dots represent firings of by location Kitchen Bath Bedroom Living room Computer Session Normal activity pattern for this individual. BIG changes from normal! The reason: the community had a norovirus outbreak; residents ate in their apartments! Specific Activity: Walking in MCI is slow and declining faster over time Right Panel - Automated daily walking speed measurements for an individual derived from an in-home sensor line operating over a period of 16 months showing the normal variability and range in this metric. Red dots: conventional single in-person stop-watch measurements. Kaye et al. Gait & Posture, Pattern returns mostly to normal. Lower Panel Walking speed trajectories over time are characteristic of MCI. Dodge et al. Neurology, 2012 MCI cases 10X more likely in Slow Group Number of Weeks Controlled for Tinetti Balance in addition to age (at baseline), sex, yrs of education 3

Direct Assessment of Everyday Cognition: (Prospective Memory) Medication Adherence: A Sensitive Measure of Cognitive Function 100 Medtracker Device.

, Technology and Aging, 2007 ; Hayes T et al..journal of Aging Health, 2009; Hayes T et al.

wks Based on ADAScog: Lower Cognition Group (n =18) vs Higher Cognition Group (n = 20) Very mild cognitive change in independent elderly is associated with medication adherence Medication adherence

a very early marker of cognitive and functional impairment. 90 80 % Adherent Prospective memory task i.e., probability of remembering to take medications as directed tracked using a familiar plastic

4 Direct Assessment of Everyday Cognition: (Prospective Memory) Medication Adherence: A Sensitive Measure of Cognitive Function 100 Medtracker Device. Each pill compartment is instrumented to record door openings and closings. Hayes et al., Proceedings : Engineering in Medicine and Biology Soc, 2006; Leen T, et al., Technology and Aging, 2007 ; Hayes T et al..journal of Aging Health, 2009; Hayes T et al.telemedicine Jounal and E-Health, 2009 Remote computer memory testing Adherence assessed with MedTracker taking a vitamin BID; target times set by seniors Mean Age - 83 yrs Assessed continuously x 5 wks Based on ADAScog: Lower Cognition Group (n =18) vs Higher Cognition Group (n = 20) Very mild cognitive change in independent elderly is associated with medication adherence Medication adherence can be a very early marker of cognitive and functional impairment % Adherent Prospective memory task i.e., probability of remembering to take medications as directed tracked using a familiar plastic pill box instrumented to record time of door openings (shown at right) vs Conventional episodic memory task e.g., recall a list of unrelated words * Significantly worse Adherence in Lower Cognition Group Median time within 53.4 mins of goal Median time within 12.0 mins of goal Lower Cognition Higher Cognition Hayes T et al., Journal of Aging Health, 2009 Video chats as social engagement An individual has the option to press response buttons or respond into phone handset which through automated speech recognition (ASR) records responses. The number of repeat instructions, hold presses and time of responses can also be recorded Computer use and memory impairment NIE Mean Days on Computer 20 Goals of continuous assessment Mean 1.5 hours on computer/per day at baseline month MCI Over time: Less use days per month Less use time when in session More variable in use pattern over time Month of Continuous Monitoring Be unobtrusive Identify highest risk individuals Early detection of onset Start early treatment Prevent acute events & hospitalizations Maintain independence Efficiently use resources & labor Save money Faster clinical trials Kaye, et al Kaye, et al. AAIC,

5 Grateful Acknowledgements Extraordinary research since 2004 Only research group in the world Largest community-based cohort Most characterized with standard clinical AND in-home activity data Longest follow up Remain the world leader in continuous assessment research Numerous research assistants, technicians, programmers, analysts, and faculty collaborators, as well as the families and research volunteers who let us explore their daily life in their homes. Willamette View Mirabella Portland Holladay Park Plaza Rose Villa Terwilliger Plaza Mary s Woods Questions? 5

The Art of Collaboration:

THE BETTER WORLD REPORT PART ONE The Art of Collaboration: The Relationships That Bring Academic Innovations to the Marketplace 2008 Edition www.betterworldproject.net 91 High-Tech Partnership Yields Technological