Clinical Manifestations

Troubling behavioral symptoms such as mood changes or agitation are highly prevalent during the course of Alzheimer's disease and related dementias (ADRD). Effective management is dependent upon understanding the causes and precipitants of behavioral symptoms. The objective of our studies is to evaluate the role of the physical ambient environment in instigating symptoms. Participants are from two studies: 1) MOnitoring DEmentia-Related Agitation Using Technology Evaluation (MODERATE) which focuses on agitation in people with later-stage dementia, and 2) Monitoring Apathy, Depression and Anxiety Using Technology Evaluation (ADA) which focuses on apathy, depression and anxiety in older adults with or without cognitive decline. A commercially available, multifunction environmental sensor, Awair Omni, was deployed in the room where the participant sleeps, measuring levels of temperature, humidity, carbon dioxide (CO ), total volatile organic compounds (VOC), particulate matter 2.5 (PM ), noise and light every 5 minutes. Additionally, a multi-sensor array (bed pressure mats, motion sensors, and wearables) is deployed in homes to objectively measure participants' behaviors. Caregivers in MODERATE report agitation level/event experienced by their partners while participants in ADA self-report their level of symptoms via weekly online surveys. To date, 9 dyads (persons with cognitive decline and their caregivers) have enrolled in MODERATE and 9 participants are enrolled in ADA. 3135 days of data have been collected for MODERATE while 849 days of data have been collected for ADA. Mean participant characteristics: age = 75±8 years; 48% women; Blind MoCA = 13.2±7.96. For 4 weeks from 12/19/2022 to 1/15/2023, ambient environmental conditions identified (mean±SD): temperature = 21 ±2.0°C; humidity = 41±7.6%; VOC = 195±263 ppm; CO = 651±225 ppm; particulate matter 2.5 = 2.4±13 µg/m ; noise = 52±4.3 dBA; light = 9.5±40 Lux. The home environments are individually heterogeneous with high variability over time across multiple environmental conditions. Reports of behavioral symptoms show high week-to-week variability as well. Proposed methods of analyzing such data include generalized linear mixed model. This in situ environmental sensing approach provides more objective and timely data to enable identifying the relationship between physical environments and the behaviors of older adults at risk of or with ADRD. The knowledge generated will help prevent or mediate symptoms