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Development of a proxy-free objective assessment tool of instrumental activities of daily living in mild cognitive impairment using smart home technologies

: Jekel, K.; Damian, M.; Storf, H.; Hausner, L.; Frölich, L.


Journal of Alzheimer's disease : JAD 52 (2016), Nr.2, S.509-517
ISSN: 1875-8908
ISSN: 1387-2877
Fraunhofer IESE ()

Background: The assessment of activities of daily living (ADL) is essential for dementia diagnostics. Even in mild cognitive impairment (MCI), subtle deficits in instrumental ADL (IADL) may occur and signal a higher risk of conversion to dementia. Thus, sensitive and reliable ADL assessment tools are important. Smart homes equipped with sensor technology and video cameras may provide a proxy-free assessment tool for the detection of IADL deficits.
Objective: The aim of this paper is to investigate the potential of a smart home environment for the assessment of IADL in MCI.
Method: The smart home consisted of a two-room fiat equipped with activity sensors and video cameras. Participants with either MCI or healthy controls (HC) had to solve a standardized set of six tasks, e.g., meal preparation, telephone use, and finding objects in the flat.
Results: MCI participants needed more time (1384 versus 938 seconds, p < 0.001) and scored less total points (48 versus 57 points, p < 0.001) while solving the tasks than HC. Analyzing the subtasks, intergroup differences were observed for making a phone call, operating the television, and retrieving objects. MCI participants showed more searching and task-irrelevant behavior than HC. Task performance was correlated with cognitive status and IADL questionnaires but not with participants' age.
Conclusion: This pilot study showed that smart home technologies offer the chance for an objective and ecologically valid assessment of IADL. It can be analyzed not only whether a task is successfully completed but also how it is completed. Future studies should concentrate on the development of automated detection of IADL deficits.