1. INTERPRETATION OF RESULTS & CONCLUSIONS
Utility of Actigraphy as an agitation-monitoring tool in advanced dementia patients : A pilot study Amer M. Burhan1,2, Amber Knuff 3,5, Lulijeta Pallaveshi 2, Tom Ross2, & Dallas Seitz. 4,5 1Schulich School of Medicine and Dentistry, Department of Psychiatry; 2 Geriatric Psychiatry at Parkwood Institute-Mental Health; 3 Queen’s University, Centre for Neuroscience Studies; 4Geriatric Psychiatry at Queens University; 5Providence Care, Kingston ON Poster to The Eighth Canadian Conference on Dementia, Ottawa ON October 1-3, 2015
Note. *≤0.05; **≤0.01; ***≤ CMAI=Cohen-Mansfield Agitation Inventory; NPI= Neuropsychiatric Inventory; CSDD= Cornell Scale for Depression in Dementia; MMA=Mean motor activity.# NPI Agitation related items subscore includes the sum of NPI subscores for Agitation, Disinhibition, Aberrant Motor Behaviour, and Irritability.
Table 1. Demographic characteristics of participants of the sample from Kingston and London sites
INTRODUCTION
Results
Variable
Total sample Kingston
Total sample London
(N=15)
(N=10)
Age, Mean (SD)
74.3 (9.24)
76.5 (6.92)
Male gender, N (%)
11 (73.33)
6 (66.67)
Duration of time in LTC or hospital (months)
41.80 (90.09)
19.8 (12.91)
Independence in Activities of Daily Living
Katz ADL, Mean (SD)
2.53 (1.73)
1.4 (0.84)
Medical comorbidity
Charlson Score, Mean (SD)
5.46 (1.51)
6.7 (1.34)
Neuropsychiatric Symptoms
CMAI Score, Mean (SD)
47.07 (13.86)
68.5 (13.39)
CMAI Verbal Agitation Subscore, Mean (SD)
6.07 (1.98)
17.7 (7.04)
CMAI Non-Aggressive Physical Agitation Subscore, Mean, (SD)
10.80 (5.94)
25.7 (8.69)
CMAI Aggressive Physical Agitation Subscore, Mean (SD)
12.93 (4.42)
25.1 (6.94)
NPI Score, Mean (SD)
15.80 (9.29)
13.7 (3.83)
NPI Agitation Score, Mean (SD)
3.13 (2.92)
2.5 (0.53)
CSDD Score, Mean (SD)
3.67 (2.64)
9.8 (4.02)
CGI-S Score, Mean (SD)
3.93 (0.96)
5.1 (0.88)
Cognitive Impairment
MMSE Scores, Mean (SD)
10.4 (7.76)
3.3 (4.50)
GDS Score, Mean (SD)
5.67 (0.49)
6.7 (048)
The global prevalence of older adults with dementia is increasing and neuropsychiatric symptoms (NPS) such as agitation or aggression are common among older adults.
Accurate measurement of NPS is necessary for diagnosis and management of these challenging behaviors.
The use of actigraphy or electronic motion analysis to measure NPS in older adults with dementia may allow for a more accurate, detailed, and objective measures of NPS.
Improvements in measurement of NPS may facilitate better clinical outcomes through early detection of NPS and assessment of treatment response.
Purpose: To evaluate the application of actigraphy to the measurement of NPS in older adults with dementia in geriatric psychiatry inpatient settings and assess the feasibility of using actigraphy to measure NPS in this population.
Objectives: 1. To determine the actigraphic characteristics of individuals who have dementia with lower compared to higher severity of agitation using portable electronic actigraphs;
2. To evaluate whether specific patterns of motor activity recorded by actigraphy are correlated with agitation in older adults with dementia; and
3. To determine key facilitators and barriers to the use of actigraphy for measuring agitation and other NPS.
The Actigraph sensor was well tolerated by participants.
The sample from the two sites is relatively similar though the London sample trended to be more impaired cognitively and functionally (Table 1)
Significant correlations were identified between MMA from one end and CMAI total score and NPI total and sub-scales (Table 2)
Table 2. Correlations between other neuropsychiatric symptom measures and mean motor activity counts
Variable
24-hour MMA
(r-value, P- value)
Daytime MMA
Evening MMA
Nighttime MMA
Kingston site (N=15)
NPI Total Score
0.47 (0.081)
0.44 (0.098)
0.41 (0.127)
0.26 (0.355)
NPI Agitation Related Items Subscore#
0.63 (0.012)*
0.67 (0.006)**
0.62 (0.014)*
0.04 (0.897)
CSDD Total Score
0.19 (0.502)
0.19 (0.507)
0.15 (0.594)
0.08 (0.769)
London site (N=10)
0.37 (0.291)
0.47 (0.168)
0.39 (0.271)
0.18 (0.623)
0.85 (0.002)**
0.88 (<0.001)***
0.42 (0.225)
0.22 (0.549)
0.41 (0.240)
0.076 (0.834)
0.80 (0.005)**
Figure 1. Correlations between CMAI measures and 24- hour and evening mean motor activity counts
RESULTS Cont’d
INTERPRETATION OF RESULTS & CONCLUSIONS
Clinical rating scales of agitation depend on direct observation and familiarity with the patient
Variability in scores on clinical rating scales can result from frequent staff turn over and high staff/patient ratio
Actigraphy appears to be a promising tool to monitor agitation in dementia and may offer an alternative to direct observation
There was some variability in correlation data between Kingston and the London site, this might be due to differences in the severity of cognitive and functional impairment, differences in staff rating on CMAI between the two sites, and smaller sample size in London
METHODS
Study Design
Cross-sectional study to test our hypothesis that higher levels of agitation will be correlated with higher motor activity as measured by Actigraphy
Participants
A total of 25 patients with advanced dementia were recruited from 2 inpatient geriatric psychiatry dementia units (London and Kingston Ontario) and one LTC facility secure dementia unit (Kingston Ontario)
Outcome measures:
Actigraphic movement data
Clinical and demographic characteristics
ACKNOWLEDGEMENTS
Funding for this project was provided through an
Ontario Research Coalition Centre for Studies in Aging, Health Early Researcher Award; the R. S. McLaughlin Fellowship
Award, and SJHC-London President Award for Innovation
Figure 2: Actigraph devise and data output