Selecting Remote Measurement Technologies to Optimize Assessment of Function in Early Alzheimer's Disease: A Case Study

Despite the importance of function in early Alzheimer’s disease (AD), current measures
are outdated and insensitive. Moreover, COVID-19 has heighted the need for remote
assessment in older people, who are at higher risk of being infection and are particularly
advised to use social distancingmeasures, yet the importance of diagnosis and treatment
of dementia remains unchanged. The emergence of remote measurement technologies
(RMTs) allows for more precise and objective measures of function. However, RMT
selection is a critical challenge. Therefore, this case study outlines the processes through
which we identified relevant functional domains, engaged with stakeholder groups to
understand participants’ perspectives and worked with technical experts to select
relevant RMTs to examine function. After an extensive literature review to select functional
domains relevant to AD biomarkers, quality of life, rate of disease progression and loss of
independence, functional domains were ranked and grouped by the empirical evidence
for each. For all functional domains, we amalgamated feedback from a patient advisory
board. The results were prioritized into: highly relevant, relevant, neutral, and less relevant.
This prioritized list of functional domains was then passed onto a group of experts in the
use of RMTs in clinical and epidemiological studies to complete the selection process,
which consisted of: (i) identifying relevant functional domains and RMTs; (ii) synthesizing
proposals into final RMT selection, and (iii) verifying the quality of these decisions.
Highly relevant functional domains were, “difficulties at work,” “spatial navigation and
memory,” and “planning skills and memory required for task completion.” All functional
domains were successfully allocated commercially available RMTs that make remote
measurement of function feasible. This case study provides a set of prioritized functional
domains sensitive to the early stages of AD and a set of RMTs capable of targeting them.
RMTs have huge potential to transform the way we assess function in AD—monitoring

for change and stability continuously within the home environment, rather than during
infrequent clinic visits. Our decomposition of RMT and functional domain selection into
identify, synthesize, and verify activities, provides a pragmatic structure with potential to
be adapted for use in future RMT selection processes.