Td-p-012: establishing objective biomarkers related to time and effort spent on caregiving

There are few tools to assess objective measures of caregiving for patients with dementia. Current tools primarily use subjective questionnaires that can be subject to inaccuracies in self-reporting. Home-based, remote-sensing computer systems are able to capture outcome measures related to cognition and everyday functioning and could provide more accurate and unbiased measures related to time and effort spent on caregiving. Here we present preliminary data on sensor-based outcome measures that differ between care partners with reported low and high levels of care burden. Data is derived from EVALUATE-AD, a clinical trial to detect standard dementia treatment transitions enrolling 30 homes with participants who have mild cognitive impairment or early-stage Alzheimer's disease and their care partner (60 total participants). A pervasive sensing and computing system is deployed in each couple's home continuously providing data on measures related to caregiver engagement (e.g. time together, sleep disruption). Care partners respond weekly on-line to queries regarding changes to their health and medications and complete questionnaires related to burden level (Zarit Burden Interview) and factors that may influence burden, including patient functional status (FAQ) and neuropsychiatric symptoms (NPI), at baseline and every 3 months during the trial. Preliminary data to date from eleven homes is comprised of sleep data from 774 nights and step counts from 899 days. Care partners (n=11) were on average 69 years old, with a mean ZBI score of 10.2 (range 1-19). Completion rate for the weekly health survey by care partners was 85%. Care partners reporting a high level of burden (n=8) had longer total sleep time (median: 8.4 vs. 7.9 hrs/night; p<0.001) with no difference in sleep latency (median: 10.0 vs. 11.0 mins; p=0.27) compared to those with low burden (n=3). Care partners with high self-reported burden also had higher total daily step counts (median: 5144 vs. 2769 steps/day; p<0.001). Care partners are accepting of the unobtrusive home-based assessment system including completing a weekly health survey regularly. This system provides a novel method to objectively assess and quantify ecologically valid measures that could be used to identify changes in levels of care need and burden.