Digital Health Solutions For Dementia Care: Apps, Wearables, And Remote Monitoring

  • Jean Stael MD - PhD Candidate, Université Notre Dame of Haiti
  • Ghufran Al SayedMBChB, University of Manchester; MPH, University of Manchester
  • Lauren WillisBachelor of Science in Medical Sciences and Engineering, UCL

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What is dementia?

The prevalence of dementia continues to rise globally. There is an urgent need for innovative approaches that can enhance the quality of care and support both patients with dementia and medical providers.1 The World Health Organisation defines dementia as “a syndrome that can be caused by a number of diseases which over time destroy nerve cells and damage the brain. These conditions may affect memory, thinking, and the ability to perform daily activities.” 

The most common form of dementia is Alzheimer’s disease. It accounts for a big portion of reported cases. Next come other forms, such as vascular dementia, dementia with Lewy bodies, and groups of diseases that promote the degeneration of cells in the brain's frontal lobe.

In addition, chronic alcohol abuse, repeated brain injury, some dietary deficiencies, and certain diseases that can also affect nerves (e.g., in the context HIV) can all lead to the development of dementia.2 The condition more commonly occurs in individuals over the age of 65.1 What makes dementia particularly burdensome is its ability to evolve and worsen over time as the person get older.3

Currently, there is no cure for dementia, and individuals afflicted with it can only receive care to manage their symptoms.1 Since it impairs their ability to socialise, people with the disease are frequently left alone while they struggle to cope with their daily activities.

Dementia sufferers are among those who require healthcare services the most because of the degenerative nature of their condition. The frequency of dementia is expected to rise with population ageing.1 For this reason, the need for contemporary methods to enhance care and support for those suffering from dementia is crucial.

The importance of digital health solutions in dementia care

Sometimes conventional methods of dementia management are not sufficient to address the diverse needs of patients, or caregiver expectations. With the right preventive and primary care, hospitalisations and increased reliance on long-term care facilities could be avoided.1

Fortunately, the emergence of digital health technologies presents encouraging prospects for transforming dementia care.4 Healthcare practitioners can now give patients more proactive and individualised support, while preserving their independence and quality of life as much as possible by utilising wearables, apps, and remote monitoring systems.1

The COVID-19 pandemic highlighted the importance of telemedicine and digital technology care in dementia management.4 These technologies allowed virtual follow-up and support from a healthcare provider. However, digital solutions not only aim to address the obvious and arising challenges of dementia, but also provide paths for preventive interventions and initiatives.1

This article will explore the role of digital health solutions in dementia care, focusing on the potential of apps, wearables, and remote monitoring solutions that can improve outcomes for patients with dementia.

Apps for dementia care

Software or mobile applications with a dementia focus are made to help people with dementia and their medical providers. These apps offer a range of features, including but not limited to memory aids, cognitive stimulation exercises, medication reminders, and communication tools.1

Most dementia care apps focus on cognitive stimulation, with tablet computers being the most used devices for such apps applications.5 There is a lack of evidence-based research on the effectiveness of commercially available dementia care apps. Many apps are not being trialled or lack a scientific basis for their content.6 That’s why in this guide we only focus on apps backed by studies or created by trusted sources.

Dementia apps for training and wellbeing

Nymbl training

Traditionally, balance exercises during rehabilitation involve only a person conducting the exercises by using mirrors with the expectations of maintaining or improving balance and walking ability. Nymbl Training leverages the familiarity of a smartphone to develop a mobile application (app) that is simple enough to use and provides suitable, age-appropriate balance training and progression.

This not only cultivates adherence through engagement and gamification, but also makes the experience both enjoyable and rewarding. This approach was drawn upon research such as the feasibility and acceptability study by Enrica Papi from Imperial College London.7

Iridis

Among the first apps to be rated ‘dementia-friendly design’, Iridis was produced in 2017 as a collaboration between the University of Stirling and Space Architecture (Europe) Ltd. The app can be used by interior designers, architects and carers alike to give an indication of the physical suitability of a home for someone with dementia. The best feature of Iridis is the use of augmented reality for the design of friendly interiors for people with dementia.8

MindMate

An innovation that was designed to foster or even improve memory and cognitive abilities. Its usefulness is demonstrated by a case experiment by researcher McGoldrick. The app is designed as a personal reminder system for everyday tasks, appointments and taking medicine.9 It helps to increase the autonomy of individuals with dementia. Although limited, preliminary research suggests that there may be benefits to using MidMate in the care of people living with dementia.

Constant Therapy

Developed at Boston University, Constant Therapy brings together artificial intelligence with real-world data to revolutionise cognitive rehabilitation.10 It was the first AI cognitive rehabilitation app to be granted FDA approval.11 The Constant Therapy team at the Boston University Center for Stroke Recovery built this app to fulfil their mission of bringing evidence-based interventions to people in their rehabilitation process.

Constant Therapy provides individuals with brain exercises that have been shown to be effective for cognitive and language practice. Constant Therapy exercises are provided in an intuitive user interface that adapts to the individual’s ability. This means that the app can, for example, monitor if tasks have become too easy for a specific user, and can then offer something more difficult. This kind of cognitive exercise has been shown to increase cognitive abilities, improve speech and language function, and improve quality of life.

Daily activities and GPS apps

Tile tracker

This Bluetooth tracker is a great tool that can help people with dementia and their caregivers. The Tile tracker lets people know where their lost items are, alleviating the stress associated with misplacement. You can pair your important items with their app, such as your wallet or house keys. When within Bluetooth range (50-150 feet), Tile will sound aloud tone, helping people to find their item quickly. If the item is out of this range, the Tile app will show a map of where the item was last seen.1

GoLivePhone

Features of the GoLivePhone include the ability to prevent falls and wandering, track activity and remind users of medication. Fall risk is assessed through anomaly detection (e.g. movements out of the person’s norm) and trend analysis of movement patterns, and geo-fencing allows users and caregivers to be notified when the user leaves a designated area.

The app also has an emergency button ‘in case of incident’ that will alert caregivers immediately. The app’s user-centric design also includes a college preparation module that helps seniors plan for their departure from home and enables the use of the app by someone else.1

Medication management apps

Medication management apps can provide vital support for medication adherence and safety. Such apps can include medication reminders, dosage reminders, refill reminders and other features that help support and structure the medication administration process. Some apps might enable caregivers to remotely track adherence, and alert them in case of a missed dose.

Simple medications management apps include:

  • Medisafe
  • MediWare
  • Pill Reminder

Other apps with more advanced features include:

  • Medisafe
  • Dosecast
  • MyMeds

Wearables for dementia management

Wearables can help provide dementia patients with an improved quality of life by monitoring some aspects of their health in real-time. Take, for example, smartwatches with a built-in sensor, which can collect data on heartbeat, activity rate, sleep patterns, etc.

From this, healthcare practitioners can derive valuable conclusions about their patient's health status.12 Also, GPS-enabled wearable devices may be of great assistance to caregivers who need to monitor and locate individuals with dementia, mitigating the danger of them wandering off and getting lost.1

Interestingly, one wearable accelerometer device was able to differentiate between different types of dementia just by examining how the user walks. This advancement may also have the potential to help in fall prognosis and early diagnosis.13

Here are some examples of wearable devices and their use in dementia care:

CleverCare watch

This is a device with the functionality of a regular smartwatch and the added features of an innovative health monitoring device specifically targeted at seniors. It features not only step count and heart rate monitoring but also medication reminders, activity tracking and fall detection. The CleverCare Smartwatch comes with an easy-to-use interface and user-friendly settings that can be personalised to fit the user's needs.

LEGSys and BalanSens

LEGSys and BalanSens are portable gait (i.e. how you walk) and balance evaluation systems. With LEGSys and BalanSens, medical professionals may conduct thorough gait and balance evaluations in almost any setting, including a patient's home. Additionally, the devices can automatically produce an extensive fall risk and balance assessment. 

Physilog and MotionNode are examples of two other portable motion analysis solutions. Research has indicated that these wearable devices can determine the centre of mass trajectory more accurately than camera-based motion analysis.14 However, these devices need to be set up in a laboratory.

Other known useful devices are:

  • QMedic, a simple wristband the patient can press if they fall
  • GPS SmartSole, a GPS monitor that uses cellular technology through soles inserted in shoes to support patients likely to wander
  • SafeWander, a small sensor attached to the patient's clothes that alerts caregivers when they leave their bed

Remote monitoring solutions 

Remote monitoring technologies have become central to healthcare. They range from system remote control of home appliances and electronic communication to safety monitoring.15 In dementia management, remote monitoring technologies can track and report behavioural and physical changes using sensors or cameras placed in the home.

Combined with IoT technology, these software use pre-programmed measures to track the patient’s eating, sleeping and toileting habits. If something goes awry, it sends an alert to caregivers.16 A case in point is the GrandCare Systems, a technological tool for remote monitoring, which is equipped with sensors and communication tools that integrates with health monitoring devices, providing ageing-in-place support and even dementia care.

Another aspect to consider is that dementia often co-exists with other health conditions, such as diabetes or hypertension. Some studies suggest that IoT-based monitoring might have a prominent role when it comes to managing acute or chronic co-morbidities in this particularly clinically vulnerable population.16

Although these were encouraging findings, there is a need for more concrete evidence, derived from stronger forms of research (like randomised trials), about the long-term efficacy and benefits of such remote monitoring systems on health outcomes and quality of life for people with dementia. As these investigations progress, they are destined to reveal the true potential – or limitations – for the use of these technologies in overall care.

Challenges of implementing digital health solutions for dementia care

Digital solutions for people with dementia face the challenge of usability, which ranges from cost and acceptance to adaptation.1 One of the main challenges is the affordability of the solution –the high price tag associated with these devices and software for advanced technology can make it inaccessible for many individuals and healthcare institutions. Managing these devices is also challenging in healthcare institutions where digital solutions should be monitored and maintained across a large number of devices.

Another challenge is the integration and compatibility of digital devices when they’re used for the same purpose across different platforms. Furthermore, the acceptance and adaptation of digital solutions can be a hurdle since when considering people with dementia who may not be well-oriented in using digital solutions daily.

This needs unique approaches and support in order to incorporate and gain the capacity to use digital solutions in a way that benefits the end-user. A final challenge to consider is healthcare delivery, where the digital solution for dementia would need specialised training to support its use by healthcare professionals in dementia care. Education programmes and support are paramount in this regard.

FAQs

How can Artificial Intelligence (AI) help Alzheimer's patients?

Alzheimer’s is an ambitious adversary, but AI can help these patients stay on top of the curve – and help them maintain their independence and quality of life as much as possible. There are various data inputs that can be fed into an AI algorithm to study and track the progression of Alzheimer’s disease. They range from medical records to daily routines and cognitive tests. The insights gained will help to formulate personalised treatment plans that are tailored to the individual patient’s needs in every stage of the disease. 

An AI-powered virtual assistant could also remind a patient to take medication, attend an appointment with their doctor or a cognitive trainer, or engage in cognitive games or activities that would maintain quality of life for longer. AI-powered solutions can contribute to a patient's safety while they are at home. With smart home devices, they can identify irregularities such as a patient walking aimlessly late at night, or following a severe fall. In such a scenario, the AI system can notify the caregivers immediately.

Are there robots that help dementia patients?

PARO is a robot made to give the good feelings of having a pet without the hard work pets need. It looks like a small, white sea pup with big, soft eyes, and weighs about 6 pounds. It has parts that can recognise touch, light, noise, how warm or cold it is, and how it's being held.

This lets it react to what's around it. PARO can move its head and arms, and make happy noises when you pet it. It can learn a bit too, like knowing its name. PARO has been found to help people feel better, think clearer, and be happier, especially older folks. Engaging with PARO a lot can make people less worried and sad, and may even make it so they don't need as much medication.1

Can deep brain stimulation cure dementia?

Scientists at Imperial College London found a way to use a method called temporal interference (TI) to send electric signals to the brain through the skin and head, aiming for the hippocampus—a key spot in the brain for memory. This doesn't need any cutting into the body. Early tests with healthy people showed better memory when TI was used. 

Dr. Nir Grossman, who was in charge, says this easy method could change how we treat dementia, making it safer and easier for more people to get help. Backed by the UK Dementia Research Institute, this big step could help us learn more about how the brain works and even lead to better approaches to managing memory problems.

Summary

Digital health solutions for dementia patients, including apps, wearables, and remote self-monitoring technologies, create new possibilities for better patient outcomes. However, there are other obstacles to their wider adoption.

These include cost, device administration, acceptance, and mode of delivery. On the other hand, if we consider the benefits, the potential for digital health solutions to support dementia care is promising. They provide the opportunity for better-tailored care, constant monitoring and greater communication between individuals with dementia and healthcare professionals.

In the future, addressing the identified barriers will bring us a step closer to optimising digital health solutions to further transform dementia care and improve the quality of life for the many living with dementia and their carers.

References

  1. Shannen Kim BA, Omid B. Toloui MPH, Sachin Jain MD. Enhancing dementia care through digital health. 2017 Dec 5 [cited 2024 Apr 18];5. Available from: https://www.ajmc.com/view/enhancing-dementia-care-through-digital-health
  2. Dementia [Internet]. [cited 2024 Apr 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia
  3. The progression, signs and stages of dementia | Alzheimer’s Society [Internet]. 2021 [cited 2024 Apr 18]. Available from: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/progression-stages-dementia
  4. Cuffaro L, Di Lorenzo F, Bonavita S, Tedeschi G, Leocani L, Lavorgna L. Dementia care and COVID-19 pandemic: a necessary digital revolution. Neurol Sci [Internet]. 2020 [cited 2024 Apr 18];41(8):1977–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298162/
  5. Ye B, Chu CH, Bayat S, Babineau J, How TV, Mihailidis A. Researched apps used in dementia care for people living with dementia and their informal caregivers: systematic review on app features, security, and usability. J Med Internet Res [Internet]. 2023 Oct 12 [cited 2024 Apr 21];25:e46188. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10603562/
  6. Wozney L, Souza LMF de, Kervin E, Queluz F, McGrath PJ, Keefe J. Commercially available mobile apps for caregivers of people with alzheimer disease or other related dementias: systematic search. JMIR Aging [Internet]. 2018 Dec 7 [cited 2024 Apr 21];1(2):e12274. Available from: https://aging.jmir.org/2018/2/e12274
  7. Papi E, Chiou SY, McGregor AH. Feasibility and acceptability study on the use of a smartphone application to facilitate balance training in the ageing population. BMJ Open [Internet]. 2020 Dec 2 [cited 2024 Apr 25];10(12):e039054. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713209/
  8. University of Stirling [Internet]. [cited 2024 Apr 25]. Iridis dementia app | About. Available from: https://www.stir.ac.uk/about/faculties/social-sciences/our-research/research-groups/cedar-centre-for-environment-dementia-and-ageing-research/iridis-dementia-app/
  9. McGoldrick C, Crawford S, Evans JJ. MindMate: A single case experimental design study of a reminder system for people with dementia. Neuropsychol Rehabil. 2021 Jan;31(1):18–38.
  10. Braley M, Pierce JS, Saxena S, De Oliveira E, Taraboanta L, Anantha V, et al. A virtual, randomized, control trial of a digital therapeutic for speech, language, and cognitive intervention in post-stroke persons with aphasia. Front Neurol [Internet]. 2021 Feb 12 [cited 2024 Apr 25];12. Available from: https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.626780/full
  11. Constant Therapy [Internet]. [cited 2024 Apr 25]. Fda grants the learning corp breakthrough device designation for speech therapy app. Available from: https://constanttherapyhealth.com/brainwire/fda-grants-the-learning-corp-breakthrough-device-designation-for-speech-therapy-app/
  12. Freytag J, Mishra RK, Street RL, Catic A, Dindo L, Kiefer L, et al. Using wearable sensors to measure goal achievement in older veterans with dementia. Sensors [Internet]. 2022 Jan [cited 2024 Apr 24];22(24):9923. Available from: https://www.mdpi.com/1424-8220/22/24/9923
  13. Mc Ardle R, Del Din S, Galna B, Thomas A, Rochester L. Differentiating dementia disease subtypes with gait analysis: feasibility of wearable sensors? Gait & Posture [Internet]. 2020 Feb 1 [cited 2024 Apr 24];76:372–6. Available from: https://www.sciencedirect.com/science/article/pii/S0966636219317989
  14. Najafi B, Lee-Eng J, Wrobel JS, Goebel R. Estimation of center of mass trajectory using wearable sensors during golf swing. J Sports Sci Med [Internet]. 2015 May 8 [cited 2024 Apr 26];14(2):354–63. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424465/
  15. Gentry T. Smart homes for people with neurological disability: state of the art. NeuroRehabilitation. 2009;25(3):209–17.
  16. David MCB, Kolanko M, Del Giovane M, Lai H, True J, Beal E, et al. Remote monitoring of physiology in people living with dementia: an observational cohort study. JMIR Aging [Internet]. 2023 Mar 9 [cited 2024 Apr 24];6:e43777. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10037178/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Jean Stael

MD, Université Notre Dame of Haiti

Jean Stael is a medical graduate with a deep understanding of technology. He believes in the transformative power of technology in healthcare. He is confident that technology will continue to enhance patient care and improve health outcomes. In 2021, he was one of the winners of an Innovative Medical Entrepreneurship contest. Jean Stael also enjoys teaching and sharing his passions with others.

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