背景:额颞叶变性(FTLD)是65岁以下人群痴呆的主要原因。在FTLD进行面对面评估的几个挑战表明,迫切需要开发远程,可访问,和低负担评估技术。对轻度认知障碍的老年人在家中使用计算机的不显眼监测的研究表明,功能下降反映在计算机使用减少;然而,与智能手机使用的关联是未知的。
目的:本研究旨在表征智能手机电池使用的日常轨迹,智能手机使用的代理,并检查与FTLD严重程度临床指标的关系。
方法:参与者为231名成年人(平均年龄52.5,SD14.9岁;n=94,40.7%的男性;n=223,96.5%的非西班牙裔白人)参加了额颞叶变性的高级研究和治疗(ARTFL研究)和家族性额颞叶痴呆的纵向评估(LEFtottotalFrontompanalDeuding研究)包括49例(21.2%)患有轻度神经行为变化且无功能障碍(即,前驱FTLD),43(18.6%)伴有神经行为变化和功能障碍(即,有症状的FTLD),和139名(60.2%)临床正常成年人,其中55(39.6%)在常染色体显性遗传FTLD基因中具有杂合致病性或可能的致病性变异。参与者完成了临床痴呆评分加上国家阿尔茨海默病协调中心额颞叶变性行为和语言领域(CDR+NACCFTLD)量表,神经心理电池;神经精神清单;和脑磁共振成像。ALLFTD移动应用程序安装在参与者的智能手机上,用于远程,被动,并持续监控智能手机的使用。在平均28天(SD4.2;范围14-30)内每15分钟收集电池百分比。为了确定电池百分比的时间模式是否随疾病严重程度而变化,线性混合效应模型检查线性,二次,以及一天中的时间的立方效应以及它们与每种疾病严重程度度量对电池百分比的相互作用。模型因年龄而异,性别,智能手机类型,和估计的智能手机年龄。
结果:CDR+NACCFTLD全球评分与电池百分比的时间相互作用,因此具有前驱或有症状的FTLD的参与者在一天中显示电池百分比的变化较小(代表较少使用智能手机)比临床正常参与者(两种情况下P<.001)。其他模型显示,评估的所有认知领域的表现较差(即,执行功能,记忆,语言,和视觉空间技能),更多的神经精神症状,和较小的脑容量也与全天使用较少的电池相关(所有情况下P<.001)。
结论:这些发现支持了一个概念证明,即被动收集有关智能手机使用行为的数据与FTLD的临床损害有关。这项工作强调了未来研究的必要性,以开发和验证对神经退行性疾病的纵向临床下降敏感的被动数字标记。具有增强对神经行为变化的现实监控的潜力。
BACKGROUND: Frontotemporal lobar degeneration (FTLD) is a leading cause of dementia in individuals aged <65 years. Several challenges to conducting in-person evaluations in FTLD illustrate an urgent need to develop remote, accessible, and low-burden assessment techniques. Studies of unobtrusive monitoring of at-home computer use in older adults with mild cognitive impairment show that declining function is reflected in reduced computer use; however, associations with smartphone use are unknown.
OBJECTIVE: This study aims to characterize daily trajectories in smartphone battery use, a proxy for smartphone use, and examine relationships with clinical indicators of severity in FTLD.
METHODS: Participants were 231 adults (mean age 52.5, SD 14.9 years; n=94, 40.7% men; n=223, 96.5% non-Hispanic White) enrolled in the Advancing Research and Treatment of Frontotemporal Lobar Degeneration (ARTFL study) and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects (LEFFTDS study) Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) Mobile App study, including 49 (21.2%) with mild neurobehavioral changes and no functional impairment (ie, prodromal FTLD), 43 (18.6%) with neurobehavioral changes and functional impairment (ie, symptomatic FTLD), and 139 (60.2%) clinically normal adults, of whom 55 (39.6%) harbored heterozygous pathogenic or likely pathogenic variants in an autosomal dominant FTLD gene. Participants completed the Clinical Dementia Rating plus National Alzheimer\'s Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR+NACC FTLD) scale, a neuropsychological battery; the Neuropsychiatric Inventory; and brain magnetic resonance imaging. The ALLFTD Mobile App was installed on participants\' smartphones for remote, passive, and continuous monitoring of smartphone use. Battery percentage was collected every 15 minutes over an average of 28 (SD 4.2; range 14-30) days. To determine whether temporal patterns of battery percentage varied as a function of disease severity, linear mixed effects models examined linear, quadratic, and cubic effects of the time of day and their interactions with each measure of disease severity on battery percentage. Models covaried for age, sex, smartphone type, and estimated smartphone age.
RESULTS: The CDR+NACC FTLD global score interacted with time on battery percentage such that participants with prodromal or symptomatic FTLD demonstrated less change in battery percentage throughout the day (a proxy for less smartphone use) than clinically normal participants (P<.001 in both cases). Additional models showed that worse performance in all cognitive domains assessed (ie, executive functioning, memory, language, and visuospatial skills), more neuropsychiatric symptoms, and smaller brain volumes also associated with less battery use throughout the day (P<.001 in all cases).
CONCLUSIONS: These findings support a proof of concept that passively collected data about smartphone use behaviors associate with clinical impairment in FTLD. This work underscores the need for future studies to develop and validate passive digital markers sensitive to longitudinal clinical decline across neurodegenerative diseases, with potential to enhance real-world monitoring of neurobehavioral change.