日常生活工具活动(IADL)的细微损伤可能是疾病进展的关键预测因子,并且被认为是功能独立性的核心。轻度认知障碍(MCI)是一种与认知功能显着变化和复杂功能能力轻度损害相关的综合征。通过识别IADL损伤早期发现功能下降可以帮助早期干预策略。数字健康技术是捕获IADL相关行为的客观方法。然而,目前尚不清楚这些IADL相关行为是如何在文献中进行数字化评估的,以及MCI与正常衰老之间可以观察到哪些差异.
这篇综述旨在确定用于评估MCI患者中IADL相关行为的数字方法和指标,并报告MCI和正常衰老之间数字终点的任何统计显着差异,以及这些数字终点如何随时间变化。
从8个数据库中确定了总共16,099篇文章(CINAHL,Embase,MEDLINE,ProQuest,PsycINFO,PubMed,WebofScience,和Scopus),其中15项纳入本审查。纳入的研究必须使用连续的远程数字测量来评估通过临床诊断或评估以患有MCI为特征的成年人的IADL相关行为。本审查是根据PRISMA(系统审查和荟萃分析的首选报告项目)指南进行的。
在纳入的研究中,环境技术是评估IADL相关行为的最常用的数字方法(14/15,93%),无源红外运动传感器(5/15,33%)和接触传感器(5/15,33%)是最普遍的方法类型。数字技术用于评估5个领域的IADL相关行为:家庭以外的活动,日常技术使用,家庭和个人管理,药物管理,和取向。其他公认的领域-文化特定的任务以及社会化和交流-没有进行评估。在11种技术中记录的79项指标中,65(82%)只使用一次。关于认知谱中数字IADL终点的差异,有不一致的发现,对它们随时间的变化进行了有限的纵向评估。
尽管用于数字化评估MCI患者IADL相关行为的指标和方法范围广泛,但尚未研究与功能下降相关的几种IADL。测量多个IADL相关的数字终点可以提供比单独测量离散IADL结果更多的价值来观察功能下降。主要建议包括开发与IADL相关行为相关的合适核心指标,这些指标基于临床上有意义的结果,以帮助标准化和进一步验证数字技术与现有IADL措施。增加纵向监测对于捕获MCI患者的数字IADL终点随时间的变化是必要的。
PROSPERO国际系统评价前瞻性注册CRD4202236861;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=326861。
Subtle impairments in instrumental activities of daily living (
IADLs) can be a key predictor of disease progression and are considered central to functional independence. Mild cognitive impairment (MCI) is a syndrome associated with significant changes in cognitive function and mild impairment in complex functional abilities. The early detection of functional decline through the identification of IADL impairments can aid early intervention strategies. Digital health technology is an objective method of capturing IADL-related behaviors. However, it is unclear how these IADL-related behaviors have been digitally assessed in the literature and what differences can be observed between MCI and normal aging.
This review aimed to identify the digital methods and metrics used to assess IADL-related behaviors in people with MCI and report any statistically significant differences in digital endpoints between MCI and normal aging and how these digital endpoints change over time.
A total of 16,099 articles were identified from 8 databases (CINAHL, Embase, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and Scopus), out of which 15 were included in this review. The included studies must have used continuous remote digital measures to assess IADL-related behaviors in adults characterized as having MCI by clinical diagnosis or assessment. This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Ambient technology was the most commonly used digital method to assess IADL-related behaviors in the included studies (14/15, 93%), with passive infrared motion sensors (5/15, 33%) and contact sensors (5/15, 33%) being the most prevalent types of methods. Digital technologies were used to assess IADL-related behaviors across 5 domains: activities outside of the home, everyday technology use, household and personal management, medication management, and orientation. Other recognized domains-culturally specific tasks and socialization and communication-were not assessed. Of the 79 metrics recorded among 11 types of technologies, 65 (82%) were used only once. There were inconsistent findings around differences in digital IADL endpoints across the cognitive spectrum, with limited longitudinal assessment of how they changed over time.
Despite the broad range of metrics and methods used to digitally assess IADL-related behaviors in people with MCI, several
IADLs relevant to functional decline were not studied. Measuring multiple IADL-related digital endpoints could offer more value than the measurement of discrete IADL outcomes alone to observe functional decline. Key recommendations include the development of suitable core metrics relevant to IADL-related behaviors that are based on clinically meaningful outcomes to aid the standardization and further validation of digital technologies against existing IADL measures. Increased longitudinal monitoring is necessary to capture changes in digital IADL endpoints over time in people with MCI.
PROSPERO International Prospective Register of Systematic Reviews CRD42022326861; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326861.