Behavioral and Psychiatric Symptoms of DementiaBESINCT03297268
Behavioral and Environmental Sensing and Intervention
An observational study of Behavioral and Psychiatric Symptoms of Dementia and Dementia, run by University of Virginia at 1 site in United States.
Trial summary
This 3-phase research plan to employ Behavioral and Environmental Sensing and Intervention (BESI) will overcome the fundamental scientific barriers to realizing prediction of agitation episodes and detection early stages of dementia related agitation. Read more about this study
- Who is it for?
- Ages 50 years and older
- Conditions the study is for
- Behavioral and Psychiatric Symptoms of Dementia, Dementia, Caregivers
- What is being tested?
- Intervention with Home-Based Caregivers
- How many people
- 24 participants
- Where
- 1 siteUnited States
- Study dates
- May 2016to Aug 2019
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Community sample of people with dementia living at home with unpaid caregivers.
Who may be able to join
- Diagnosis of dementia
- Living in one home for at least 2 months without hospitalization
- Caregiver seeking support for caregiving needs
- Have a stable caregiver
- Be able to provide consent or assent
Who cannot join
- Hospitalization in the last 2 months
- Multiple and inconsistent caregivers
- Living in multiple homes
- Unable to provide consent or assent
- No known dementia
Trial locations and contacts
1 site in 1 country.
United States1 site, 1 recruiting
- Recruiting
University of Virginia
Charlottesville, Virginia, 22904
John Lach, Ph.D, jlach@virginia.edu
Tonya Smith-Jackson, Ph.D, tlsmithj@ncat.edu
About this study
Official title: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment
This 3-phase research plan to employ Behavioral and Environmental Sensing and Intervention (BESI) will overcome the fundamental scientific barriers to realizing prediction of agitation episodes and detection early stages of dementia related agitation. The goal of which is empowering caregivers to intervene early and ultimately reduce agitation, thus reducing caregiver burden and extending aging-in-place and improving the associated quality-of-life and cost benefits.
Read the detailed description
The dementia syndrome of Alzheimer's disease and other disorders is rapidly expanding due to the aging of society and the longevity of citizens. In its varying stages, care of the dementia syndrome requires differing sets of skills from the caregivers, and more skilled intervention is required as the disease progresses. These caregivers experience increased burden due to the challenges and stresses of caring. A recent systematic review of caregiver burden factors revealed dementia-related agitation to be the most prevalent factor leading caregivers to institutionalize community-dwelling loved ones with dementia. Tools that empower caregivers to proactively reduce the incidents and severity of agitation would reduce stress and increase self-efficacy, thereby extending aging-in-place and the associated quality-of-life and cost benefits.
This project proposes to develop, deploy, and evaluate such a tool and to address the fundamental scientific challenges to realizing the benefits of such a technology to caregivers and persons with dementia (PWD). The tool - BESI: Behavioral and Environmental Sensing and Intervention - will be an empowerment tool for caregivers of community-dwelling PWD. BESI comprises:
- a system of body-worn inertial sensors and in-home acoustic, light, temperature, and motion sensors,
- data analysis techniques to detect and assess agitation and environmental context from these sensor streams,
- models for the relationship between agitation and the environment that are trained for each PWD-caregiver dyad based on a\&b, and
- automated real-time notifications to the caregiver based on b\&c (e.g., detection of early agitation stages or of an environment (cumulative and/or instantaneous based on the models) that has led to agitation in the past), empowering the caregiver to intervene before agitation escalation.
- Being tested
- Intervention with Home-Based Caregivers
- Keywords
- Dementia Caregiver Empowerment, Caregiver Burden, Agitation in Dementia, Environmental Sensors, Wearable Technology
- Medical subject headings
- Behavior, Dementia, Caregiver Burden, Aberrant Motor Behavior in Dementia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Intervention with Home-Based CaregiversOther
Also called Real-time caregiver notifications
We will assess whether real-time notifications of potential agitation via a wearable wrist device improves caregiver self-efficacy.
| Study group | Role | What they receive |
|---|---|---|
| Phase 1-Controlled Validation & Study Planning | Phase 1 is focused on refining and ultimately verifying BESI's basic sensing and notification functionality and validating BESI's environmental assessments in a controlled setting - namely the laboratory and homes of two healthy volunteers. This phase also serves to support further requirements gathering to refine BESI for community-based deployment. No interventions are delivered. | |
| Phase 2 - In-situ Validation and Ethnographic Analysis | Phase 2 starts the deployment of the technology within a community context, with the goals of validating the system's ability to assess agitation and environmental events in-situ and developing the cyber-sociophysical system models based on the dyad-specific relationship between agitation and the environment. A hybrid remote ethnographic methodology will be used, combining remote BESI measurement and caregiver diaries and a time-series design for the administration of the assessment battery. | |
| Phase 3 - Intervention with Home-Based Caregivers | Phase 3 is the intervention phase and the full realization of BESI. The goal is to employ the validated assessment capabilities and the developed modeling techniques to enable real-time, dyad-specific caregiver notifications that empower a caregiver to intervene with the PWD and/or environment before agitation escalation. In addition to validation of the BESI's ability to provide such appropriate notifications, Phase 3 will also serve as a pilot study about the effect that these notifications have on caregiver empowerment (as measured by self-efficacy) and the frequency and severity of PWD agitation, thus providing proof-of-concept for BESI's potential to improve dyad outcomes and motivating a larger-scale followup study to establish proof-of-practice. Receives: Other: Intervention with Home-Based Caregivers |
What is being measured
The primary outcome is the main question the study is designed to answer.
Improved Caregiver Self-Efficacy
Increased scores on Revised Scale for Caregiver Self-Efficacy
Measured: 30 days
Decreased Caregiver Burden
Zarit Burden Interview score lowered
Measured: 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Sep 2017
- Study startMay 2016
- Primary completionAug 2019 (estimated)
- Study completionAug 2019 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (33)Papers the sponsor has linked to this study.
- Other trials for Behavioral and Psychiatric Symptoms of DementiaStudies of the same condition, open and under way.
- More trials run by University of VirginiaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Family based
- Time perspective
- Cross-sectional
- Enrolment
- 24 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Virginia
- Sponsor type
- University, hospital or other
- Collaborators
- Carilion Clinic, North Carolina Agriculture & Technical State University
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03297268
- Sponsor's protocol ID
- 0037457000
- Other IDs
- 1418622
- Acronym
- BESI
- Status last verified
- Sep 2017
- First submitted
- 20 Sep 2017
- Last updated
- 29 Sep 2017
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement. 2016 Apr;12(4):459-509. doi: 10.1016/j.jalz.2016.03.001.
PubMed 27570871Friedman EM, Shih RA, Langa KM, Hurd MD. US Prevalence And Predictors Of Informal Caregiving For Dementia. Health Aff (Millwood). 2015 Oct;34(10):1637-41. doi: 10.1377/hlthaff.2015.0510.
PubMed 26438738Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. I. A conceptual review. J Am Geriatr Soc. 1986 Oct;34(10):711-21. doi: 10.1111/j.1532-5415.1986.tb04302.x.
PubMed 3531296Cummings J, Mintzer J, Brodaty H, Sano M, Banerjee S, Devanand DP, Gauthier S, Howard R, Lanctot K, Lyketsos CG, Peskind E, Porsteinsson AP, Reich E, Sampaio C, Steffens D, Wortmann M, Zhong K; International Psychogeriatric Association. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015 Jan;27(1):7-17. doi: 10.1017/S1041610214001963. Epub 2014 Oct 14.
PubMed 25311499Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989 May;44(3):M77-84. doi: 10.1093/geronj/44.3.m77.
PubMed 2715584Colombo M, Vitali S, Cairati M, Vaccaro R, Andreoni G, Guaita A. Behavioral and psychotic symptoms of dementia (BPSD) improvements in a special care unit: a factor analysis. Arch Gerontol Geriatr. 2007;44 Suppl 1:113-20. doi: 10.1016/j.archger.2007.01.017.
PubMed 17317443Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschanz JT; Cache County Investigators. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008 Feb;23(2):170-7. doi: 10.1002/gps.1858.
PubMed 17607801Sansoni J, Anderson KH, Varona LM, Varela G. Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature. Ann Ig. 2013 May-Jun;25(3):235-46. doi: 10.7416/ai.2013.1926.
PubMed 23598807Fonareva I, Oken BS. Physiological and functional consequences of caregiving for relatives with dementia. Int Psychogeriatr. 2014 May;26(5):725-47. doi: 10.1017/S1041610214000039. Epub 2014 Feb 10.
PubMed 24507463Mausbach BT, Chattillion EA, Roepke SK, Patterson TL, Grant I. A comparison of psychosocial outcomes in elderly Alzheimer caregivers and noncaregivers. Am J Geriatr Psychiatry. 2013 Jan;21(1):5-13. doi: 10.1016/j.jagp.2012.10.001. Epub 2013 Jan 2.
PubMed 23290198Epstein-Lubow G, Gaudiano B, Darling E, Hinckley M, Tremont G, Kohn R, Marino LJ Jr, Salloway S, Grinnell R, Miller IW. Differences in depression severity in family caregivers of hospitalized individuals with dementia and family caregivers of outpatients with dementia. Am J Geriatr Psychiatry. 2012 Sep;20(9):815-9. doi: 10.1097/JGP.0b013e318235b62f.
PubMed 21997604Bankole A, Anderson M, Smith-Jackson T, Knight A, Oh K, Brantley J, Barth A, Lach J. Validation of noninvasive body sensor network technology in the detection of agitation in dementia. Am J Alzheimers Dis Other Demen. 2012 Aug;27(5):346-54. doi: 10.1177/1533317512452036.
PubMed 22815084Rowe M, Lane S, Phipps C. CareWatch: A Home Monitoring System for Use in Homes of Persons With Cognitive Impairment. Top Geriatr Rehabil. 2007 Jan 1;23(1):3-8. doi: 10.1097/00013614-200701000-00003.
PubMed 20454554Sacco G, Joumier V, Darmon N, Dechamps A, Derreumaux A, Lee JH, Piano J, Bordone N, Konig A, Teboul B, David R, Guerin O, Bremond F, Robert P. Detection of activities of daily living impairment in Alzheimer's disease and mild cognitive impairment using information and communication technology. Clin Interv Aging. 2012;7:539-49. doi: 10.2147/CIA.S36297. Epub 2012 Dec 4.
PubMed 23271900Perlman CM, Hirdes JP. The aggressive behavior scale: a new scale to measure aggression based on the minimum data set. J Am Geriatr Soc. 2008 Dec;56(12):2298-303. doi: 10.1111/j.1532-5415.2008.02048.x.
PubMed 19093929
Study at a glance
From the registry record, last updated by the sponsor on 29 Sep 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment
- ClinicalTrials.gov ID
- NCT03297268
- Acronym / sponsor ID
- BESI / 0037457000
- Keywords
- Dementia Caregiver Empowerment, Caregiver Burden, Agitation in Dementia, Environmental Sensors, Wearable Technology
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 24 participants (estimated)
- Lead sponsor
- University of VirginiaUniversity, hospital or other
- Collaborators
- Carilion Clinic, North Carolina Agriculture & Technical State University
- Study start
- May 2016 (actual)
- Primary completion
- Aug 2019 (estimated)
- Study completion
- Aug 2019 (estimated)
- First posted
- 29 Sep 2017 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This 3-phase research plan to employ Behavioral and Environmental Sensing and Intervention (BESI) will overcome the fundamental scientific barriers to realizing prediction of agitation episodes and detection early stages of dementia related agitation. The goal of which is empowering caregivers to intervene early and ultimately reduce agitation, thus reducing caregiver burden and extending aging-in-place and improving the associated quality-of-life and cost benefits.
Detailed description
The dementia syndrome of Alzheimer's disease and other disorders is rapidly expanding due to the aging of society and the longevity of citizens. In its varying stages, care of the dementia syndrome requires differing sets of skills from the caregivers, and more skilled intervention is required as the disease progresses. These caregivers experience increased burden due to the challenges and stresses of caring. A recent systematic review of caregiver burden factors revealed dementia-related agitation to be the most prevalent factor leading caregivers to institutionalize community-dwelling loved ones with dementia. Tools that empower caregivers to proactively reduce the incidents and severity of agitation would reduce stress and increase self-efficacy, thereby extending aging-in-place and the associated quality-of-life and cost benefits.
This project proposes to develop, deploy, and evaluate such a tool and to address the fundamental scientific challenges to realizing the benefits of such a technology to caregivers and persons with dementia (PWD). The tool - BESI: Behavioral and Environmental Sensing and Intervention - will be an empowerment tool for caregivers of community-dwelling PWD. BESI comprises:
- a system of body-worn inertial sensors and in-home acoustic, light, temperature, and motion sensors,
- data analysis techniques to detect and assess agitation and environmental context from these sensor streams,
- models for the relationship between agitation and the environment that are trained for each PWD-caregiver dyad based on a\&b, and
- automated real-time notifications to the caregiver based on b\&c (e.g., detection of early agitation stages or of an environment (cumulative and/or instantaneous based on the models) that has led to agitation in the past), empowering the caregiver to intervene before agitation escalation.
Study design
- Observational model
- Family based
- Time perspective
- Cross-sectional
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Phase 1-Controlled Validation & Study Planning | – | –Phase 1 is focused on refining and ultimately verifying BESI's basic sensing and notification functionality and validating BESI's environmental assessments in a controlled setting - namely the laboratory and homes of two healthy volunteers. This phase also serves to support further requirements gathering to refine BESI for community-based deployment. No interventions are delivered. |
| Phase 2 - In-situ Validation and Ethnographic Analysis | – | –Phase 2 starts the deployment of the technology within a community context, with the goals of validating the system's ability to assess agitation and environmental events in-situ and developing the cyber-sociophysical system models based on the dyad-specific relationship between agitation and the environment. A hybrid remote ethnographic methodology will be used, combining remote BESI measurement and caregiver diaries and a time-series design for the administration of the assessment battery. |
| Phase 3 - Intervention with Home-Based Caregivers | – | Other: Intervention with Home-Based CaregiversPhase 3 is the intervention phase and the full realization of BESI. The goal is to employ the validated assessment capabilities and the developed modeling techniques to enable real-time, dyad-specific caregiver notifications that empower a caregiver to intervene with the PWD and/or environment before agitation escalation. In addition to validation of the BESI's ability to provide such appropriate notifications, Phase 3 will also serve as a pilot study about the effect that these notifications have on caregiver empowerment (as measured by self-efficacy) and the frequency and severity of PWD agitation, thus providing proof-of-concept for BESI's potential to improve dyad outcomes and motivating a larger-scale followup study to establish proof-of-practice. |
Who may qualify
- Ages
- 50 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Community sample of people with dementia living at home with unpaid caregivers.
Key inclusion criteria (5 listed)
- Diagnosis of dementia
- Living in one home for at least 2 months without hospitalization
- Caregiver seeking support for caregiving needs
- Have a stable caregiver
- Be able to provide consent or assent
Key exclusion criteria (5 listed)
- Hospitalization in the last 2 months
- Multiple and inconsistent caregivers
- Living in multiple homes
- Unable to provide consent or assent
- No known dementia
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Intervention with Home-Based CaregiversAlso: Real-time caregiver notificationsWe will assess whether real-time notifications of potential agitation via a wearable wrist device improves caregiver self-efficacy. | Other | Phase 3 - Intervention with Home-Based Caregivers |
Primary outcome
Improved Caregiver Self-Efficacy
Time frame: 30 days
Increased scores on Revised Scale for Caregiver Self-Efficacy
Decreased Caregiver Burden
Time frame: 30 days
Zarit Burden Interview score lowered
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Sep 2017.
- Background: PubMed 27570871Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement. 2016 Apr;12(4):459-509. doi: 10.1016/j.jalz.2016.03.001.
- Background: PubMed 26438738Friedman EM, Shih RA, Langa KM, Hurd MD. US Prevalence And Predictors Of Informal Caregiving For Dementia. Health Aff (Millwood). 2015 Oct;34(10):1637-41. doi: 10.1377/hlthaff.2015.0510.
- Background: PubMed 3531296Cohen-Mansfield J, Billig N. Agitated behaviors in the elderly. I. A conceptual review. J Am Geriatr Soc. 1986 Oct;34(10):711-21. doi: 10.1111/j.1532-5415.1986.tb04302.x.
- Background: PubMed 25311499Cummings J, Mintzer J, Brodaty H, Sano M, Banerjee S, Devanand DP, Gauthier S, Howard R, Lanctot K, Lyketsos CG, Peskind E, Porsteinsson AP, Reich E, Sampaio C, Steffens D, Wortmann M, Zhong K; International Psychogeriatric Association. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015 Jan;27(1):7-17. doi: 10.1017/S1041610214001963. Epub 2014 Oct 14.
- Background: PubMed 2715584Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989 May;44(3):M77-84. doi: 10.1093/geronj/44.3.m77.
- Background: PubMed 17317443Colombo M, Vitali S, Cairati M, Vaccaro R, Andreoni G, Guaita A. Behavioral and psychotic symptoms of dementia (BPSD) improvements in a special care unit: a factor analysis. Arch Gerontol Geriatr. 2007;44 Suppl 1:113-20. doi: 10.1016/j.archger.2007.01.017.
- Background: PubMed 17607801Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, Breitner JC, Steffens DC, Tschanz JT; Cache County Investigators. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008 Feb;23(2):170-7. doi: 10.1002/gps.1858.
- Background: PubMed 23598807Sansoni J, Anderson KH, Varona LM, Varela G. Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature. Ann Ig. 2013 May-Jun;25(3):235-46. doi: 10.7416/ai.2013.1926.
- Background: PubMed 24507463Fonareva I, Oken BS. Physiological and functional consequences of caregiving for relatives with dementia. Int Psychogeriatr. 2014 May;26(5):725-47. doi: 10.1017/S1041610214000039. Epub 2014 Feb 10.
- Background: PubMed 23290198Mausbach BT, Chattillion EA, Roepke SK, Patterson TL, Grant I. A comparison of psychosocial outcomes in elderly Alzheimer caregivers and noncaregivers. Am J Geriatr Psychiatry. 2013 Jan;21(1):5-13. doi: 10.1016/j.jagp.2012.10.001. Epub 2013 Jan 2.
- Background: PubMed 21997604Epstein-Lubow G, Gaudiano B, Darling E, Hinckley M, Tremont G, Kohn R, Marino LJ Jr, Salloway S, Grinnell R, Miller IW. Differences in depression severity in family caregivers of hospitalized individuals with dementia and family caregivers of outpatients with dementia. Am J Geriatr Psychiatry. 2012 Sep;20(9):815-9. doi: 10.1097/JGP.0b013e318235b62f.
- Background: PubMed 22815084Bankole A, Anderson M, Smith-Jackson T, Knight A, Oh K, Brantley J, Barth A, Lach J. Validation of noninvasive body sensor network technology in the detection of agitation in dementia. Am J Alzheimers Dis Other Demen. 2012 Aug;27(5):346-54. doi: 10.1177/1533317512452036.
- Wearable device used in BESILink provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Behavioral and Psychiatric Symptoms of Dementia and Dementia, run by University of Virginia at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 29 Sep 2017. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Improved Caregiver Self-Efficacy (time frame: 30 days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03297268, which also lists 33 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2017.