Problem behaviors in demented patients, such as combativeness, wandering, and sundowning, are a major source of caregiver stress and a common reason for the institutionalization of the patient. Based on the well-accepted notion that these behavioral disturbances stem from agitation, we propose a novel approach of using electrodermal activity (EDA) to assess the degree of agitation in dementia patients. The goals are, first, to detect increasing agitation before it surfaces in the patient's behavior and, second, to devise methods of reducing the agitation to prevent the aberrant behavior from appearing. Almost no work has been done using EDA in dementia patients. The literature indicates that the latency and amplitude in dementia patients are similar to normal controls, implying that we can probe the individual's responses as with standard biofeedback techniques. Because of the paucity of data available, we will first develop a set of standard methods for studying EDA in dementia patients and monitoring spontaneous activity. Our group has developed a wearable device that will measure EDA and transmit it using Bluetooth. We will validate the device against the usual reference method, skin conductivity measured at the finger tips. Once validated, we can monitor long-term spontaneous EDA in dementia patients. This will allow the study of circadian rhythms in dementia patients, which is important in and of itself. These long term studies will aid in identifying EDA activity that may precede agitation. We will also study stimuli that decrease EDA, which the patient cannot do on his own as is required by standard biofeedback techniques and which may prevent the progression to problem agitation. If successful, this work could decrease caregiver burden and help dementia patients remain in their homes longer.

Public Health Relevance

The long-term goal of this line of research is to develop techniques for objectively monitoring the response of patients suffering from dementia in order to quantitatively assess therapeutic interventions for problem behaviors such as combativeness, sundowning, and wandering. The techniques described here will be useful both at home and in institutional VA settings. This project will enable us to develop methods to understand responses of patients who have lost the ability to communicate their feelings. Specifically, we will use electrodermal activity (EDA) to assess the response of patients to various stimuli (visual, auditory, tactile, gustatory); we will then determine the degree to which the patient's EDA correlates with events in the patient's environment. We hypothesize that certain types of environmental stimuli evoke stress responses which register as EDA independently of the patient's ability to communicate and which aggravate problem behaviors. Therefore, EDA may identify negative stimuli and serve as an outcome measure of interventions to mitigate the problem behavior. Our approach may lead to a general method that can individualize interventions in dementia patients by identifying which stimuli in the environment may lead to EDA responses and, therefore, be precursors to problem behaviors. These interventions may include removing the stimulus, counteracting the stimulus with known calming activities, or objectively quantifying the effect of drug. The device developed at the MIT Media Laboratory would allow rapid extension to clinical wards and, potentially, home environments. These aspects support the RR&D priorities to develop therapies for neurodegenerative and age-related degenerative diseases and facilitate the rapid translation of such therapies into clinical use for maximum benefit to Veterans and to create new physical rehabilitation strategies for Veterans suffering from Parkinson's disease, Alzheimer's disease, and other neurodegenerative conditions.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Type
Veterans Administration (I21)
Project #
1I21RX001932-01A1
Application #
9031483
Study Section
Special Emphasis Panel (RRDS)
Project Start
2016-01-01
Project End
2017-12-31
Budget Start
2016-01-01
Budget End
2016-12-31
Support Year
1
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Ern Memorial Veterans Hospital
Department
Type
DUNS #
080042336
City
Bedford
State
MA
Country
United States
Zip Code
01730