title: Development of a Proxy-Free Objective Assessment Tool of Instrumental Activities of Daily Living in Mild Cognitive Impairment Using Smart Home Technologies.
abstract: The assessment of activities of daily living (ADL) is essential for dementia diagnostics. Even in mild cognitive impairment (MCI), subtle deficits in instrumental ADL (IADL) may occur and signal a higher risk of conversion to dementia. Thus, sensitive and reliable ADL assessment tools are important. Smart homes equipped with sensor technology and video cameras may provide a proxy-free assessment tool for the detection of IADL deficits.
  
  
  
  The aim of this paper is to investigate the potential of a smart home environment for the assessment of IADL in MCI.
  
  
  
  The smart home consisted of a two-room flat equipped with activity sensors and video cameras. Participants with either MCI or healthy controls (HC) had to solve a standardized set of six tasks, e.g., meal preparation, telephone use, and finding objects in the flat.
  
  
  
  MCI participants needed more time (1384 versus 938 seconds, p <  0.001) and scored less total points (48 versus 57 points, p <  0.001) while solving the tasks than HC. Analyzing the subtasks, intergroup differences were observed for making a phone call, operating the television, and retrieving objects. MCI participants showed more searching and task-irrelevant behavior than HC. Task performance was correlated with cognitive status and IADL questionnaires but not with participants' age.
  
  
  
  This pilot study showed that smart home technologies offer the chance for an objective and ecologically valid assessment of IADL. It can be analyzed not only whether a task is successfully completed but also how it is completed. Future studies should concentrate on the development of automated detection of IADL deficits.
authors.affiliation: Network Aging Research, Heidelberg University, Germany.|Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Jekel
authors.affiliation: Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany.
authors.forename: Marinella
authors.initials: M
authors.lastname: Damian
authors.affiliation: Fraunhofer Institute for Experimental Software Engineering IESE, Kaiserslautern, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Storf
authors.affiliation: Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Hausner
authors.affiliation: Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Frölich
mesh_terms: D056044:Actigraphy / Q000295:instrumentation / Q000379:methods*; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D005160:Facility Design and Construction / Q000379:methods; D005260:Female; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009043:Motor Activity; D009483:Neuropsychological Tests; D010865:Pilot Projects; D013997:Time Factors; D014741:Video Recording / Q000295:instrumentation / Q000379:methods*
keywords: Instrumental activities of daily living; mild cognitive impairment; performance-based measures; smart homes