An Ambient Intelligence System for the Monitoring, Empowerment, and Disease Evolution Prediction for Patients with Mild Cognitive Impairment

An Ambient Intelligence System for the Monitoring, Empowerment, and Disease Evolution Prediction for Patients with Mild Cognitive Impairment

Konstantinos Votis (Information Technologies Institute, Greece), Sofia Segkouli (Information Technologies Institute, Greece & Greek Association of Alzheimer's disease and Related Disorders, Greece), Anastasios Drosou (Information Technologies Institute, Greece), Dimitrios Tzovaras (Information Technologies Institute, Greece) and Magda Tsolaki (Greek Association of Alzheimer's disease and Related Disorders, Greece & Aristotle University of Thessaloniki, Greece)
DOI: 10.4018/978-1-4666-8234-4.ch012
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Abstract

This chapter addresses the critical issue of exploration and integration of environmental factors as well as the effect of activities of daily living with medical and biological factors in order to monitor and predict AD/MCI disease progression and evolution. Thus, traditional approaches to clinical research and practice requires population statistics and therefore takes into account only the average biological behaviour of the disease, independently of the person specific clinical history, environmental factors, as well as the daily activity interactions in relation to historical data. The proposed system will use IT-based tools (including also 3D gaming environments) in order to address specific cognitive and physical/motor parameters and ADLs (activities of daily living) factors within AD, and MCI domain and aim at improving their diagnosis, evaluating their variations along the progress of an Alzheimer disease and its different steps, and supporting the stimulation/training of the patient affected by the disease.
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Introduction

The age structure of the EU population is projected to change dramatically, as shown in the population pyramids presented below by Eurostat [Age structure of population in EU 27, 2012]. Thus, the population aged 65 and above will increase very markedly throughout the projection period, almost tripling from 23.7 million in 2010 to 62.4 million in 2060.

Figure 1.

Age structure of population in EU 27 (The 2012 ageing report)

This ageing trend has severe implications for the prevalence of age-related declines in physical and cognitive abilities, which will cause inevitably breakdowns in self-management and hinder older peoples’ chance to live independently. Especially, disorders of the central nervous system are important causes of morbidity and mortality worldwide and have a highly significant impact on societal welfare. Many of these disorders remain untreatable despite recent progress in understanding their pathogenesis, and the need for further research is as great as ever.

Moreover, on 22 September 2011 and during the Summit on Non Communicable Diseases (including cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, as well as others NCDs such as neuropsychiatric disorders and arthritis) that was organised by the United Nations, the final political declaration of the summit specifically recognized neurological diseases, including Alzheimer’s disease (Alzheimer’s Disease International (ADI) has become a Full Partner in the NCD Alliance with the other four disease areas) and other dementias, as an important cause of morbidity that contribute to the global NCD burden and that NCD prevention programmes and health care interventions has to provide equitable access to effective programmes for these illnesses.

The most common form of dementia is Alzheimer’s disease (AD), which accounts for between 60% to 80% of cases worldwide [Alzheimer’s Association disease facts and figures report (2009). ]. AD involves the damage and the death of brain cells and the breakdown of their connections, which in turn impacts on patient’s memory, thought, and language. These are often translated, in a mild stage, in memory problems, difficulties in communicating, reduction of meaningful activities and maintaining a healthy routine and an increasing lack of perceived safety which ultimately leads to more isolation and diminished social contact.

So, with 35 million persons living with dementia worldwide today and the growing problem especially in lower and middle income countries, adding Alzheimer’s considerations to the health planning effort at any country and World Health Organization level is a major leap forward toward mobilizing the imagination and resources of the public health community. Furthermore, most elderly people wish to stay at home as long as possible which in fact reduces the pressure from nursing homes. Conversely, this burden is placed over informal carers such as: spouses, children, other family members and friends. This in turn will create a high demand for living independent solutions which seems to be one of the basic principles most older people thrive to adhere to as long as possible.

Unfortunately, currently implemented methods to predict the Alzheimer’s disease do not show a sufficiently exploration and integration of environmental factors as well as the effect of activities of daily living with medical and biological factors in order to monitor and predict disease progression and evolution. Traditional approaches to clinical research and practice requires population statistics and therefore takes into account only the average biological behaviour of the Alzheimer disease, independently of the person specific clinical history, environmental factors, as well as the daily activity interactions in relation to historical data.

Key Terms in this Chapter

Home Tele-Monitoring: A patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors and potentially improves their medical conditions.

Instrumental Activities of Daily Living (IADL): There are the activities of daily living that are not fundamental for functioning but they are important for let an individual living independently in a community.

Ambient Intelligence Monitoring: Ambient Intelligence has been defined as the field to study and create embodiments for smart environments that not only react to human events through sensing, interpretation and service provision, but also learn and adapt their operation and services to the users over time.

Mild Cognitive Impairment (MCI): Subjects with a mild cognitive impairment (MCI) are usually elderly who have a memory impairment beyond that expected for age, and still with normal functioning in daily activities but yet not demented.

Smart Environments: A smart home can be viewed as an environment in which computing and communications technologies employ artificial intelligence techniques to assess individuals’ cognitive and physical health. In a smart home, sensor events are generated while residents perform their daily activities.

3D Gaming Environment: 3D environment beyond its entertainment value could serve as a valid and powerful tool for cognition activities assessment. It plays also an important role in cognitive skills training.

Alzheimer Disease: Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by cognitive and intellectual deficits and behavior disturbance.

Virtual Reality: This term refers to the family of technologies used to deliver computer-mediated simulated environments which can offer to its visitors (users) immersive experiences. Although there are different implementations, each one with its own unique characteristics, most of VR systems simulate physical presence in imaginable or existing places. Sensory experiences include virtual haptic, sight, sound and even smell and taste in some cases.

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