A Digital Biomarker for Identifying Changes in Daily Activity Patterns

Malnutrition and dehydration are strongly associated with increased cognitive and functional decline in people living with dementia (PLWD), as well as an increased rate of hospitalisations in comparison to their healthy counterparts. Extreme changes in eating and drinking behaviours can often lead to malnutrition and dehydration, accelerating the progression of cognitive and functional decline and resulting in a marked reduction in quality of life. Unfortunately, there are currently no established methods by which to objectively detect such changes. Here, we present the findings of a quantitative analysis conducted on in-home monitoring data collected from 73 households of PLWD using Internet of Things technologies. The Coronavirus 2019 (COVID-19) pandemic has previously been shown to have dramatically altered the behavioural habits, particularly the eating and drinking habits, of PLWD. Using the COVID-19 pandemic as a natural experiment, we show that there were significant changes in kitchen activities at the group level within a subset of 21 households of PLWD that were continuously monitored for 499 days, with an overall increase in day-time activities and a decrease in night-time activity observed in both single and multiple occupancy households. We further present preliminary results suggesting it is possible to proactively detect episodic and gradual changes in behaviours using remote monitoring data as a proxy for behaviours that cannot be directly measured. Together, these results pave the way to introduce improvements into the monitoring of PLWD in naturalistic settings and for shifting from reactive to proactive care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Engineering and Physical Sciences Research Council (EPSRC) PROTECT Project (grant number: EP/W031892/1) and the UK DRI Care Research and Technology Centre funded by Medical Research Council (MRC) and Alzheimer’s Society (grant number: UKDRI–7002). Alina–Irina Serban was supported by the UK Research and Innovation Centre for Doctoral Training in Artificial Intelligence (UKRI CDT in AI) for Healthcare, see http://ai4health.io (grant number: P/S023283/1). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Remote-monitoring data was collected from households of people living with dementia as part of the ongoing Minder study being conducted at the UK Dementia Research Institute Care Research & Technology centre (see https://ukdri.ac.uk/centres/care-research-technology and https://mindermeetingplace.com). The London-Surrey Borders Research Ethics Committee formerly South West London Ethics Committee (see https://www.hra.nhs.uk/about-us/committees-and-services/res-and-recs/search-research-ethics-committees/london-surrey-borders/) gave ethical approval for the Minder study protocol. The Surrey and Borders NHS Trust information governance committee (for more information go to https://www.sabp.nhs.uk/aboutus/policies/digital-governance/infoGovPol) and the Imperial College information governance team (for more information go to https://www.imperial.ac.uk/admin-services/secretariat/college-governance/charters/policies-regulations-and-codes-of-practice/policy-framework/) reviewed and approved the information governance procedures. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All code and data (the latter of which has been anonymized) have been made publicly available on GitHub at [https://github.com/NVFL/a\_digital\_biomarker\_for\_identifying\_changes\_in\_daily\_activity_patterns][1] [1]: https://github.com/NVFL/a_digital_biomarker_for_identifying_changes_in_daily_activity_patterns