The use of home-based conversations for detecting early dementia: Protocol for the CUBOId TV task

Abstract

ABSTRACTIntroductionLimitations in effective dementia therapies mean that early diagnosis and monitoring are critical for disease management, but current clinical tools are impractical and/or unreliable, and disregard short-term symptom variability. Behavioural biomarkers of cognitive decline, such as speech, sleep and activity patterns, can manifest prodromal pathological changes. They can be continuously measured at home with smart sensing technologies, and permit leveraging of interpersonal interactions for optimising diagnostic and prognostic performance. Here we describe the ContinUous behavioural Biomarkers Of cognitive Impairment (CUBOId) study, which explores the feasibility of multimodal data fusion for in-home monitoring of mild cognitive impairment (MCI) and early Alzheimer’s disease (AD). The report focuses on a subset of CUBOId participants who perform a novel speech task, the “TV task”, designed to track changes in ecologically valid conversations with disease progression.Methods and AnalysisParticipants have diagnoses of MCI or AD, and controls are their live-in partners with no such diagnosis. Multimodal activity data were passively acquired from wearables and in-home fixed sensors over periods ranging from 8 to 25 months. At 2 time points participants completed the TV task over 5 days by recording audio of their conversations as they watched a favourite TV programme, with further testing to be completed after removal of the sensor installations. Behavioural testing is supported by neuropsychological assessment for deriving behavioural ground truths on cognitive status. Deep learning will be used to generate fused multimodal activity-speech embeddings for optimisation of diagnostic and predictive performance from speech alone.Ethics and disseminationCUBOId was approved by an NHS Research Ethics Committee (Wales REC; ref: 18/WA/0158) and is sponsored by University of Bristol. It is also supported by the National Institute for Health Research (NIHR) Clinical Research Network West of England. Results will be reported at conferences and in peer-reviewed scientific journals.ARTICLE SUMMARYStrengths and limitationsTo our knowledge, this is the first study to simultaneously characterise longitudinal, ecologically valid diagnostic trajectories across a broad range of behavioural domains relevant to cognitive decline “in the wild”, allowing construction of shared multimodal embeddings for dementia diagnosis from speech aloneParticipants’ live-in partners are contextually matched controls, accounting for differences across participants’ home environments and lifestylesMeasurements of cognitive status from neuropsychological testing form ground truths for behavioural biomarkers of cognitive declineLimited sample size and restricted demographics may confer limited generalisability of findings to other populationsBehavioural and neuropsychological testing timelines disrupted and desynchronised due to COVID-19