Instrumentation & Measurement Magazine 24-6 - 68

Home-Based Assessment of Cognition
and Health Measures: The Collaborative
Aging Research Using Technology (CART)
Initiative and International Collaborations
Neil W. Thomas, Zachary Beattie, Thomas Riley, Scott Hofer, and Jeffrey Kaye
H
ome-based sensor platforms offer novel methods
to evaluate individuals with cognitive impairment.
Having high-frequency information on
changes in health status, activity, and functioning in reallife
settings could improve our ability to assess and provide
care to these individuals. The insidious onset, slow progression,
and day-to-day variability seen in neurodegenerative
disorders make them ideal candidates for continuous forms
of assessment. There have been significant advances in technologies
related to the monitoring of health and well-being
through pervasive computing, wearable technologies, wireless
and mobile technologies, and high dimensional data
analytics. High-frequency assessment with digital technologies
has been demonstrated to provide earlier and more
sensitive detection of changes in health, cognition, and
function, with the potential to improve person-specific diagnosis,
prevention, and treatment enabled by health care
professionals.
Despite the proliferation of digital technologies, there
has been relatively limited uptake of these approaches into
clinical research [1] and the electronic information and
communication technologies used in healthcare (ehealth)
[2]. Significant limitations affecting translation into these
fields include the lack of standards for sensor technology
data collection, small size or short duration studies
in cohorts lacking diversity, and the limited scalability of
home-based sensor platforms. The Collaborative Aging
Research using Technology (CART) initiative was established
to create a platform and research initiative that could
help to address the issues with research into home-based
assessment. In this review, we will discuss benefits of
home-based assessment methods for the evaluation of individuals
with cognitive impairment, the current state of
home-based monitoring technologies for cognitive health
and well-being, the development of the CART technology
platform for aging research and challenges associated with
this initiative, and the use of this platform in international
collaborations.
68
Elements of Real-life, Home-based
Monitoring
Home-based sensor platforms offer potential advantages for
the collection of information related to cognition and physical
measures compared to conventional assessment methods.
Objective data is collected on outcome measures that are not
subject to observer bias or inter-rater and test-retest reliability.
Although many cognitive tests are employed to detect
mild cognitive impairment (MCI), there is evidence that the
reliability of these tests over time is lacking. In a systematic review,
only one of the fifteen screening instruments identified
had published evidence of adequate test-retest reliability [3].
Data from sensor and computing systems is time-stamped and
recorded at the moment an event occurs, helping to avoid inaccuracies
in self-report and risks of recall bias. Room location
data from a home-based assessment platform demonstrated a
lack of concordance between self-reported activity and sensorbased
monitoring over the same two-hour period [4]. Activity
and behavior can be assessed in real-time in natural environments
using home-based sensors, making it ecologically valid
and relevant to the participant's everyday life [5]. In the clinic
setting, tests are performed that measure surrogate markers
of physical and activities of daily living (ADLs) that do not
always give a clear picture of functional status. For example,
although determining gait speeds using a stopwatch remains
a reliable method [6], it may not provide the most accurate estimate
of " real world " gait speed. In clinic settings, older adults
tend to walk faster [7] and the observed walks are susceptible
to variability in the verbal instructions given to patients [8].
The laboratory and clinical setting cannot recreate the many
environmental variables present in the community and home
settings.
Home-based Assessment Technologies
for Measuring Cognitive Health and
Well-being
Systematic reviews of studies examining digital biomarker
and in-home technologies for monitoring cognition [9], [10]
IEEE Instrumentation & Measurement Magazine
1094-6969/21/$25.00©2021IEEE
September 2021
Instrumentation & Measurement Magazine 24-6

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