title: Unobtrusive measurement of daily computer use to detect mild cognitive impairment.
abstract: BACKGROUND
  Mild disturbances of higher order activities of daily living are present in people diagnosed with mild cognitive impairment (MCI). These deficits may be difficult to detect among those still living independently. Unobtrusive continuous assessment of a complex activity such as home computer use may detect mild functional changes and identify MCI. We sought to determine whether long-term changes in remotely monitored computer use differ in persons with MCI in comparison with cognitively intact volunteers.
  
  
  METHODS
  Participants enrolled in a longitudinal cohort study of unobtrusive in-home technologies to detect cognitive and motor decline in independently living seniors were assessed for computer use (number of days with use, mean daily use, and coefficient of variation of use) measured by remotely monitoring computer session start and end times.
  
  
  RESULTS
  More than 230,000 computer sessions from 113 computer users (mean age, 85 years; 38 with MCI) were acquired during a mean of 36 months. In mixed-effects models, there was no difference in computer use at baseline between MCI and intact participants controlling for age, sex, education, race, and computer experience. However, over time, between MCI and intact participants, there was a significant decrease in number of days with use (P = .01), mean daily use (∼1% greater decrease/month; P = .009), and an increase in day-to-day use variability (P = .002).
  
  
  CONCLUSIONS
  Computer use change can be monitored unobtrusively and indicates individuals with MCI. With 79% of those 55 to 64 years old now online, this may be an ecologically valid and efficient approach to track subtle, clinically meaningful change with aging.
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Neurology Service, Portland Veteran Affairs Medical Center, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA. Electronic address: kaye@ohsu.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kaye
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Mattek
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Hiroko H
authors.initials: HH
authors.lastname: Dodge
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Hayes
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Austin
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hatt
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wild
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Jimison
authors.affiliation: Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pavel
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000369:Aged, 80 and over; D000465:Algorithms; D016009:Chi-Square Distribution; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000503:physiopathology*; D015331:Cohort Studies; D003201:Computers; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: Activities of daily living; Assessment of cognitive disorders/dementia; Cohort studies; Computer use; Mild cognitive impairment