Changes in noncognitive symptoms such as mood, loneliness, pain, and need for assistance may be potential early markers of mild cognitive impairment (MCI) and Alzheimer's disease and related disorders (ADRD) in older adults. These changes can be subtle and fluctuating, and thus easily missed during intermittent clinic visits.
Objective
To assess the relationship of changes in self-perceived internal states and needs to the development of cognitive impairment over time.
Methods
Weekly online reports of health-related activities and mood in relation to MCI were assessed for up to 2.9 years in older adults participating in the Oregon Life Laboratory, a study using home-based unobtrusive remote sensing of physical, cognitive, behavioral, physiological, and health-related activities.
Results
The analytic sample included 129 cognitively healthy volunteers followed for a mean of 2.9 ± 1.2 years. Mean age was 83.5 ± 7.8 years, mean education was 15.7 ± 2.7 years, and 76% were female. Twenty-two participants (17%) developed MCI or dementia while 107 remained cognitively healthy. Over time, more of the participants destined to develop MCI reported: (1) loneliness (p = 0.049), (2) low mood (p = 0.08), (3) pain intensity (p = 0.03) and pain interference (p = 0.01), and (4) needing in-home assistance (p = 0.02) than those remaining cognitively healthy. Baseline scores assessing these symptoms were not clinically concerning, predictive of MCI, nor significantly different between groups.
Conclusions
Longitudinal home-based online assessment of non-cognitive aspects of function or internal states (loneliness, mood, pain, needing more assistance) can be sensitive early indicators of changes in brain function leading to MCI and ADRD.
JinHJunghaenelDUOrriensB, et al.Developing early markers of cognitive decline and dementia derived from survey response behaviors: protocol for analyses of preexisting large-scale longitudinal data. JMIR Res Protoc2023; 12: e44627.
2.
RosenbergPBMielkeMMApplebyBS, et al.The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. Am J Geriatr Psychiatry2013; 21: 685–695.
3.
IsmailZAgüera-OrtizLBrodatyH, et al.The mild behavioral impairment checklist (MBI-C): a rating scale for neuropsychiatric symptoms in pre-dementia populations. J Alzheimers Dis2017; 56: 929–938.
4.
LussierFZPascoalTAChamounM, et al.Mild behavioral impairment is associated with β-amyloid but not tau or neurodegeneration in cognitively intact elderly individuals. Alzheimers Dement2020; 16: 192–199.
5.
YoonEJLeeJYKwakS, et al.Mild behavioral impairment linked to progression to Alzheimer's disease and cortical thinning in amnestic mild cognitive impairment. Front Aging Neurosci2023; 14: 1051621.
6.
TanEYLKöhlerSHamelREG, et al.Depressive symptoms in mild cognitive impairment and the risk of dementia: a systematic review and comparative meta-analysis of clinical and community-based studies. J Alzheimers Dis2019; 67: 1319–1329.
7.
TwaitELWuJHKamariotiM, et al.Association of amyloid-beta with depression or depressive symptoms in older adults without dementia: a systematic review and meta-analysis. Transl Psychiatry2024; 14: 25.
8.
BanningLCPRamakersIHGBDeckersK, et al.Apolipoprotein E and affective symptoms in mild cognitive impairment and Alzheimer's disease dementia: a systematic review and meta-analysis. Neurosci Biobehav Rev2019; 96: 302–315.
9.
HarringtonKDRoqueNAStrengerJ, et al.Loneliness and subjective cognitive impairment in preclinical Alzheimer’s disease and healthy aging. Alzheimers Dement2022; 18: e069279.
10.
RenYSavadlouAParkS, et al.The impact of loneliness and social isolation on the development of cognitive decline and Alzheimer's disease. Front Neuroendocrinol2023; 69: 101061.
11.
DonovanNJOkerekeOIVanniniP, et al.Association of higher cortical amyloid burden with loneliness in cognitively normal older adults. JAMA Psychiatry2016; 73: 1230–1237.
12.
SalinasJBeiserASSamraJK, et al.Association of loneliness with 10-year dementia risk and early markers of vulnerability for neurocognitive decline. Neurology2022; 98: e1337–e1348.
13.
RosenbergPB. Loneliness as a marker of brain amyloid burden and preclinical Alzheimer disease. JAMA Psychiatry2016; 73: 1237–1238.
14.
BrawerS. Is detection of preclinical Alzheimer’s disease possible?Sci J Lander Coll Arts Sci2018; 11: 27–33.
15.
SperlingRMorminoEJohnsonK. The evolution of preclinical Alzheimer's disease: implications for prevention trials. Neuron2014; 84: 608–622.
16.
MarkREBrehmerY. Preclinical Alzheimer's dementia: a useful concept or another dead end?Eur J Ageing2022; 19: 997–1004.
17.
LeeseMIMattekNBernsteinJPK, et al.The survey for memory, attention, and reaction time (SMART): preliminary normative online panel data and user attitudes for a brief web-based cognitive performance measure. Clin Neuropsychol2023; 37: 1257–1275.
18.
KayeJHayesTZitzelbergerT, et al.Deploying wide scale in home assessment technology. In: MihailidisABogerJKautzH (eds) Technology and aging, vol 21. Selected Papers from the 2007 International Conference on Technology and Aging. Amsterdam: IOS Press, 2008, pp.19–26.
19.
SeelyeALeeseMDorociakK, et al.Feasibility of in-home sensor monitoring to detect mild cognitive impairment in aging military veterans: prospective observational study. JMIR Form Res2020; 4: e16371.
20.
KayeJAMaxwellSAMattekN, et al.Intelligent systems for assessing aging changes: home-based, unobtrusive and continuous assessment of aging. J Gerontol B Psychol Sci Soc Sci2011; 66(Suppl 1): i180–i190.
21.
DorociakKEMattekNLeeJ, et al.The survey for memory, attention, and reaction time (SMART): development and validation of a brief web-based measure of cognition for older adults. Gerontology2021; 67: 740–752.
22.
MuurlingMAu-YeungWMBeattieZ, et al.Differences in life space activity patterns between older adults with mild cognitive impairment living alone or as a couple: cohort study using passive activity sensing. JMIR Aging2023; 6: e45876.
23.
FredricksonBLKahnemanD. Duration neglect in retrospective evaluations of affective episodes. J Pers Soc Psychol1993; 65: 45–55.
24.
KabacinskaKSharmaNKayeJ, et al.Investigating the concept of participant burden in aging technology research. BMC Geriatr2020; 20: 50.
25.
BeattieZMillerLMAlmirolaC, et al.The collaborative aging research using technology initiative: an open, sharable, technology-agnostic platform for the research community. Digit Biomark2020; 6: 100–118.
26.
TarnanasITsolakiAWiederholdM, et al.Five-year biomarker progression variability for Alzheimer's disease dementia prediction: can a complex instrumental activities of daily living marker fill in the gaps?Alzheimers Dement (Amst)2015; 1: 521–532.
27.
ThomasNBeattieZRileyT, et al.Home-based assessment of cognition and health measures: the collaborative aging research using technology (CART) initiative and international collaborations. IEEE Instrum Meas Mag2021; 24: 68–78.
28.
SeelyeAMattekNSharmaN, et al.Weekly observations of online survey metadata obtained through home computer use allow for detection of changes in everyday cognition before transition to mild cognitive impairment. Alzheimers Dement2018; 14: 187–194.
29.
SeelyeAMattekNHowiesonDB, et al.Embedded online questionnaire measures are sensitive to identifying mild cognitive impairment. Alzheimer Dis Assoc Disord2016; 30: 152–159.
30.
BernsteinJDorociakKMattekN, et al.Unobtrusive, in-home assessment of older adults’ everyday activities and health events: associations with cognitive performance over a brief observation period. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn2022; 29: 781–798.
31.
DawsonWMattekNGothardS, et al.Ascertaining out-of-pocket costs of dementia care: feasibility study of a web based weekly survey. JMIR Form Res2024; 8: e56878.
32.
BerridgeCZhouYRobillardJM, et al.Companion robots to mitigate loneliness among older adults: perceptions of benefit and possible deception. Front Psychol2023; 14: 1106633.
33.
BerridgeCZhouYLazarA, et al.Control matters in elder care technology:: evidence and direction for designing it in. DIS (Des Interact Syst Conf)2022; 2022: 1831–1848.
34.
PiauASteinmeyerZMattekN, et al.Caregiving in older adults; experiences and attitudes toward smart technologies. J Clin Med2023; 12: 1789.
35.
PiauAMattekNCrisseyR, et al.When will my patient fall? Sensor-based in-home walking speed identifies future falls in older adults. J Gerontol A Biol Sci Med Sci2020; 17: 968–973.
36.
WuCDodgeHReynoldsC, et al.In-home mobility frequency and stability in older adults living alone with or without MCI: introduction of new metrics. Front Digit Health2021; 3: 764510.
37.
WuCYDodgeHHGothardS, et al.Unobtrusive sensing technology detects ecologically valid spatiotemporal patterns of daily routines distinctive to persons with mild cognitive impairment. J Gerontol A Biol Sci Med Sci2022; 77: 2077–2084.
38.
LennonJCHantkeNMattekN, et al.Mood and activity changes during the COVID-19 pandemic in rural and urban veterans and their cohabitants. Clin Gerontol2023; 46: 759–766.
39.
LeeseMBernsteinJDorociakK, et al.Older adults’ daily activity and mood changes detected during the COVID-19 pandemic using remote unobtrusive monitoring technologies. Innov Aging2021; 5: igab032.
40.
ThielkeSMMattekNCHayesTL, et al.Brief report: associations between observed in-home behaviors and self-reported low mood in community-dwelling older adults. J Am Geriatr Soc2014; 62: 685–689.
41.
HuangHCTsengYMChenYC, et al.Diagnostic accuracy of the clinical dementia rating scale for detecting mild cognitive impairment and dementia: a bivariate meta-analysis. Int J Geriatr Psychiatry2021; 36: 239–251.
42.
KukullWALarsonEBTeriL, et al.The mini-mental state examination score and the clinical diagnosis of dementia. J Clin Epidemiol1994; 47: 1061–1067.
SalviFMillerMDGrilliA, et al.A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc2008; 56: 1926–1931.
46.
LiangKYZegerSL. Longitudinal data analysis using generalized linear models. Biometrika1986; 73: 13–22.
47.
NganduTLehtissaloJSolomonA, et al.A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomized controlled trial. Lancet2015; 385: 2255–2263.
48.
KivipeltoMMangialascheFSnyderHM, et al.World-Wide FINGERS network: a global approach to risk reduction and prevention of dementia. Alzheimers Dement2020; 16: 1078–1094.
49.
NianogoRARosenwohl-MackAYaffeK, et al.Risk factors associated with Alzheimer disease and related dementias by sex and race and ethnicity in the US. JAMA Neurol2022; 79: 584–591.
50.
NortonSMatthewsFEBarnesDE, et al.Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. Lancet Neurol2014; 13: 788–794.
51.
ChenJWangXXuZ. The relationship between chronic pain and cognitive impairment in the elderly: a review of current evidence. J Pain Res2023; 16: 2309–2319.
52.
HuYHSeoDCHuberL, et al.Chronic non-cancer pain and associated risks of incident mild cognitive impairment and Alzheimer’s disease and related dementias in middle-aged and older adults. J Appl Gerontol2024; 43: 1438–1448.
53.
RouchIEdjoloALaurentB, et al.Association between chronic pain and long-term cognitive decline in a population-based cohort of elderly participants. Pain2021; 162: 552–560.
54.
SunHLBaiWChenP, et al.Pain trajectories and their associations with cognition among older adults: a 10-year cohort study from network perspective. Age Ageing2024; 53: afae054.
55.
ZhangXGaoRZhangC, et al.Evidence for cognitive decline in chronic pain: a systematic review and meta-analysis. Front Neurosci2021; 15: 737874.
56.
EzzatiAWangCKatzMJ, et al.The temporal relationship between pain intensity and pain interference and incident dementia. Curr Alzheimer Res2019; 16: 109–115.
57.
VeroneseNKoyanagiASolmiM, et al.Pain is not associated with cognitive decline in older adults: a four-year longitudinal study. Maturitas2018; 115: 92–96.
58.
WhitlockELDiaz-RamirezLGGlymourMM, et al.Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Intern Med2017; 177: 1146–1153.
59.
van der LeeuwGEggermontLHShiL, et al.Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci2016; 71: 398–405.
60.
BellTFranzCEKremenWS. Persistence of pain and cognitive impairment in older adults. J Am Geriatr Soc2022; 70: 449–458.
61.
SmithLLópez SánchezGFShinJI, et al.Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries. Aging Clin Exp Res2023; 35: 1513–1520.
62.
de AguiarGPCGSaraivaMDKhazaalEJB, et al.Persistent pain and cognitive decline in older adults: a systematic review and meta-analysis from longitudinal studies. Pain2020; 161: 2236–2247.
